ABSTRACT
An ideal donor site for vascularized nerve grafts should have a constant anatomy,
minimal functional loss after the nerve has been sacrificed, and a dependable blood
supply parallel to the nerve over a relatively long distance. Creating a pedicle for
a free vascularized deep peroneal nerve graft with the anterior tibial vessels seems
to be a most suitable method for repairing long nerve gaps of over 20 cm and digital
nerve defects with severe finger damage. Applications of this nerve graft to digital
nerve losses with severely scarred beds created by avulsion injury, and two-stage
reconstruction in some partial brachial plexus palsies (free vascularized nerve graft
in the first stage and free vascularized muscle graft in the second stage) are well
indicated.
Advantages of this technique are: (1) A long nerve graft (up to 25 cm) can be obtained,
and anomalies are rare (the nerve is absent in only 4 percent of cases). (2) The caliber
of the vascular pedicle is large (≌3 mm). (3) The nerve has a sufficient blood supply
from the collateral blood vessels. (4) The graft can be easily obtained in the supine
position. (5) A monitoring skin flap, based on the inferior lateral peroneal artery,
can be attached to the nerve graft. (6) Sensory loss resulting from the sacrifice
of the nerve covers a minimal area. (7) A donor scar on the anterior aspect of the
lower leg is more acceptable than one on the posterior aspect because of less movement
in walking. Disadvantages of this technique are: (1) Sacrifice of the large vessels
in the lower leg may result in circulatory complications in the donor foot; to avoid
this problem, preoperative angiography is recommended. (2) The donor scar is in an
exposed area in female patients. (3) There may be temporary postoperative edema and
disability in the donor leg.
