Objective To report the clinical result of the improvedisland skin flap with distallybased sural nerve nutrient vessels in repairing skin defect in the heel, ankle or foot. Methods From August2004 to April 2005, 15 patients with skin defect in the heel, ankle or foot at distal part were treated by the improved island skin flap with distally-based of sural nerve nutrient vessels. Of 15 flaps, 12 were simplex flaps and 3 were complex flaps. These flap area ranged from 7 cm×6 cm to 11×8 cm. The donor sites were sutured directly and covered with free flap. Results All flaps survived without flap swelling and disturbance of blood circulation. The wounds of donor and recipient sites healed by first intention. The followup period ranged from 3 to 6 months. The texture of flap was soft and the color of flap was similar to that of normal skin. The foot function was excellent. Conclusion The improved island skin flap with distally-based sural nerve nutrient vessels is an ideal skin flap for repairing skin defect in the heel, ankle or foot distal part in clinical. The operation is simple and need not to anastomose blood vessel.
Objective To evaluate the clinical effect of sural nerve bridging transplantation for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy. Methods Between May 2014 and May 2016, 23 patients underwent sural nerve bridging transplantation for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy. The age ranged from 19 to 38 years (mean, 27 years). The course of disease was 1-28 months (mean, 14 months). The defect length was 1.0-1.5 cm. Preoperative main neurological sign was sensory disturbance. The chief complaint of 21 patients was a erectile dysfunction; all had normal hormone levels, and there was no other organic diseases or surgical contraindication. According to the self-assessment lists of symptom-SCL90 evaluation, 19 cases had depression, 16 cases had anxiety, and 15 cases had both anxiety and depression; 3 cases had psychological abnormalities (social barriers, etc.). According to the functional neurological evaluation standard of British Medical Research Institute, the static two-point discrimination and sensation recovery standard rating were evaluated before and after operation; sexual pleasure obstacle sensitivity, temperature sense, and other subjective improvement were recorded. The International Index of Erectile Function 5 (IIEF-5) was used to evaluate questionnaire of the patient with erectile dysfunction before and after operation. The psychological state was accessed with the self-assessment lists of symptom-SCL90 evaluation after operation. Results All incisions healed by first intention. The mean follow-up time was 8 months (range, 6-12 months). Sexual pleasure obstacle was obviously improved in 11 cases, partially improved in 5 cases; the improvements in temperature and tactile sensitivity were achieved in 21 cases; no obvious improvement was observed in 1 case. The sensation recovery standard rating, static two-point discrimination and grade of IIEF-5 were significantly improved at 3 and 6 months after operation when compared with preoperative ones (P<0.05). At 6 months after operation, symptom was improved in 14 of 19 patients with depression (73.68%), in 12 of 16 patients with anxiety (75.00%), and in 12 of 15 patients with anxiety and depression(80.00%). Conclusion Sural nerve bridging transplantation is an effective method for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy.