The Superficial Inferior Epigastric Artery Fascia Flap for Nerve Reconstruction in Rabbits

The addition of surgical angiogenesis to reconstructed peripheral nerves is argued to improve nerve regeneration. Surgical angiogenesis can be performed by wrapping a vascularized flap around the nerve graft, which is believed to enhance nerve regeneration following reconstruction. The protocol aimed to outline the surgical procedure and report long-term viability and patency for the superficial inferior epigastric artery fascia (SIEF) flap in a rabbit peroneal nerve defect model to add vascularization and enhance nerve regeneration. In this article, step-by-step instructions on the harvest and application of the pedicled adipofascial flap to add vascularization to the peroneal nerve reconstruction site are described. The technique was performed on 36 New Zealand White rabbits to assess feasibility and long-term viability. To harvest a 14 x 10 cm flap, a 14 cm paramedian abdominal incision on the ipsilateral side of the nerve reconstruction was made. After identifying the superficial inferior epigastric (SIE) vessels, the flap was dissected mediodistally, elevated toward the proximal branch of the SIE vessels, and guided through a subcutaneous inguinal tunnel to the previously exposed peroneal nerve reconstruction site, ensuring the pedicle remained free of torsion. The peroneal nerve defect was reconstructed, after which it was loosely wrapped with the harvested flap. The flap was secured, covering both anastomoses, without observed tension and compression on the flap or the reconstructed nerve. At 16 and 24 weeks postoperatively, flap viability was assessed using the milking patency test, along with an evaluation of flap color and the presence of active bleeding at its edges. At sacrifice, all SIEF flaps remained viable, with patent vessels and no flap-related complications. This flap was harvested with minimal complexity and demonstrated consistent anatomical features. Its suitability for revascularization procedures in the lower abdomen, genital area, and thigh in rabbits suggests potential translation to larger animal models.