Pilot Study of a Turnover Nerve Fascicular Flap for Noncritical Sural Nerve Gap Reconstruction

Background: This study presents a clinical series evaluating the effectiveness of nerve gap reconstruction using a vascularized turnover fascicular flap. Methods: A pilot study included 12 patients, aged 39 to 70 years (average: 54.6 y), with sural nerve gaps requiring reconstruction after injury. Sensory function was assessed using the British Medical Research Council Scale (BMRCS) and electroneuromyography preoperatively and at 12 months postoperatively. The level of neuropathic pain was assessed using a Pain Detect questionnaire. All patients underwent surgical exploration, neuroma excision, and nerve gap measurement. The size of the sural nerve defect ranged from 4 to 7 cm and was 5.33 cm on average. Reconstruction was performed using a turnover fascicular flap elevated from the proximal nerve stump according to the Koshima technique, avoiding the need for a separate donor nerve harvest. Results: At 12-month follow-up, all patients demonstrated improvement of sensitivity and nerve conduction according to electroneuromyography. The level of neuropathic pain has significantly decreased. No major complications were observed. Conclusion: This pilot study suggests that the turnover fascicular flap is a viable technique for reconstructing noncritical sensory sural nerve gaps.