Arch Hand Microsurg.  2022 Mar;27(1):99-104. 10.12790/ahm.21.0125.

Reconstruction of the sciatic nerve using bilateral vascularized sural nerve grafts: a case report

  • 1Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea


An injury of a peripheral nerve may require reconstruction for motor and sensory function recovery. However, if the nerve defect is long, especially in the lower extremities, reconstruction with successful functional recovery has proven to be difficult. We documented a case of bilateral vascularized sural nerve graft repair of a large and long sciatic nerve defect following malignant tumor resection on the posterior thigh. Although we were unable to achieve satisfactory outcomes in motor function recovery, we did achieve some degree of sensory function recovery.


Nerve injury; Sciatic nerve defect; Sural nerve graft; Vascularized nerve graft


  • Fig. 1. Magnetic resonance images of the left posterior thigh. (A) Sagittal view. (B) Axial view. In front of the hamstring muscle, a mass measuring about 1.0×6.0×2.0 cm attached to the sciatic nerve is shown.

  • Fig. 2. The tumor mass was located on the sciatic nerve and involved the surrounding muscles.

  • Fig. 3. After wide excision of the tumor mass including the sciatic nerve and surrounding tissues, an 8-cm sciatic nerve defect is shown around 4 cm above the bifurcation site.

  • Fig. 4. The sural nerve, including the lesser saphenous vein and the fascia, was elevated and harvested en bloc to form a vascularized flap from both lower legs. (A) Right lower leg. (B) Left lower leg. (C) Vascularized sural nerve by the lesser saphenous vein and the fascia.

  • Fig. 5. Repair of the sciatic nerve with the harvested bilateral vascularized sural nerve and vascular anastomosis at three sites, between two lesser saphenous veins, between the lesser saphenous vein and alongside the artery, and between the lesser saphenous vein and alongside the vein. (A) Intraoperative image. (B) Schematic diagram.

  • Fig. 6. Magnetic resonance image of the left posterior thigh at 20 months postsurgery shows no recurrence.



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