Objective To investigate a best method of obtaining the sural neurofasciocutaneous flap by observing the models of different pedicles based sural neurofasciocutaneous flaps in rabbits and the effect of different pedicles on the survival of the flaps. Methods Forty adult New Zealand rabbits (male or female, weighing 2.5-3.0 kg) were randomly divided into 4 groups (10 rabbits in each). The flaps of 7 cm × 1 cm were designed at the lateral hind legs, and the pedicle was 0.5 cmin length. In group A, the flaps were elevated based on a single perforator pedicle; in group B, the flaps were elevated based on fascia pedicle; in group C, the flaps were elevated based on perforator-plus fascia pedicle; and in group D, the flaps were elevated and sutured in situ. At 7 days after operation, the flap survival rate was recorded, and the blood flow in the center of the flap was monitored by laser doppler flowmetry. The perfusion unit (PU) was measured. Results After operation, the flaps had no obvious swell ing, and the flaps had good color at the proximal end, but pale at the distal end in groups A and B. Obvious swell ing was observed with pale color at the distal flaps in group C, but swell ing decreased gradually. However, the skin color became dark gradually in group D after operation. The flap survival rates were 74.0% ± 2.7%, 60.0% ± 2.5%, 75.0% ± 3.5%, and 0 in groups A, B, C, and D respectively after 7 days of operation. The PU values were 83.39 ± 4.25, 28.96 ± 13.49, 81.85 ± 5.93, and 8.10 ± 3.36 in groups A, B, C, and D respectively. There were significant differences in flap survival rates and PU values between groups A, B, C and group D (P lt; 0.05). Significant differences were found between groups A, C and group B (P lt; 0.05), but no significant difference between group A and group C (P gt; 0.05). Conclusion The sural neurofasciocutaneous flap based on a single perforator pedicle has a rel iable blood supply and enough venous drainage, which is one of the best methods to obtain the sural neurofasciocutaneous flap.
Objective To establ ish the experimental animal model of perforator sural neurocutaneous flap for laying a foundation of further study on its physiology and haemodynamics. Methods Thirty-five New Zealand rabbits were divided into four groups, weighing 2.5-3.0 kg and being male or female. In group A (n=5), vivisection was performed to observe thestarting point and arrangement of sural nerve, its concomitant vessels, posterior tibial artery and perforating vessel. In groups B and C (n=5), red latex and gelatin-lead oxide were injected into the concomitant arteries of sural nerve and the posterior tibial arteries respectively to observe their arrangement, the diameter and anatomasis. In group D, forty neurocutaneous flaps based on single perforator were elevated in the twenty rabbits with a size of 7 cm × 1 cm and a pedicle of 0.5 cm. The colour and condition of flaps were observed. Results The sural nerve originated from posterior tibial nerve, passed through the lateral head of the gastrocnemius at site of the popl iteal fossa, descended obl iquely to exterior, entered in the deep fascia at about (5.42 ± 0.15) cm above lateral malleolus, and descended vertically to lateral malleolus. Its concomitant artery originated from deep femoral artery with an initial diameter of (0.73 ± 0.11) mm and extended to the lateral malleolus along the sural nerve. A perforating branch of posterior tibial artery at the position of the calcaneus originated from the midpoint of the l ine connecting between the medial malleolus and the calcaneus with an initial diameter of (0.45 ± 0.01) mm. The perforating branch traversed the calcaneus to the region of the lateral malleolus, and anastomosed to the concomitant artery of the sural nerve, forming a vascular plexus around the sural nerve. In group D, two cases were excluded due to infection. The survival rate was 78.0% ± 1.5% in other 38 flaps 10days after operation. Conclusion The perforator based sural neurocutaneous flap in rabbit is a good experimental model,which has stable anamatic features and rel iable blood distribution.