| Objective In 1990s' there was a new type of flap called neurocutaneous vascular flap. Because of the advantages as the reliable blood supply, avoidance of sacrificing the major arteries, lesser injuries for donor area, simple procedure and reconstruction of sensation, it received extensive solicitude both on anatomic and clinic study. Anatomic study was carried out and based on it,the distally based neurocutaneous saphenous island flap was designed to investigate the clinic application for recovering the defect of the lower limb.Method and result: Eight fresh cadaver legs in adults were anatomically examined after the intravenous injection of the red latex. Observed the distribution and anastomosis of saphenous nerve and the concomitant vessel. The saphenous nerve was companioned with the saphenous artery and the greater saphenous vein from the knee to the ankle to dominate the sense of these zones. The diameter of the nerve was 3.5±0.25mm and the artery was 1.45±0.15mm. The upper part of the leg was in an axial pattern and the lower part was in a "chain-type anastomosing" pattern which was constituted by the anostomosis of the saphenous artery and the peroneal and posterior tibial arteries. The posterior tibial arteries got 3. 4±1.2 ramuses and the average diameter was 0.9±0.25mm with the length of 4.53±1.50cm .The vascularity of the nerve was closely connected with the vascularity of the skin and. The distally based neurocutaneous saphenous island flap pedicled with the lowest perforating branch which came from the peroneal arteries and the distance to the ankle was about 4.50±1.50cm and the highest one was 6.2cm above the ankle. So the rotation point should be higher than 7cm. According to the size and site of the defect and the rotation point, the distally based neurocutaneous saphenous island flap was designed, and it was based on the arterial axis associated with the saphenous nerve and the greater saphenous vein and the rotation point located on the top of the ankle 7cm. To corroborate the rotation point, the lowest perforating branch must be corroborated by machine. When it was impossible, the pedicle of the flap must be cut as short and wide as possible to conclude the arteries. Firstly exposed the saphenous nerve in the upper part, making sure again the location of the flap, then cut off the saphenous nerve and the greater saphenous vein and artery. Carved the skin and obtained the flap on the deep fascia. Reserved the tissue of 3～4cm on both sides of the pedicle to ensure that the saphenous nerve, concomitant vessel and the greater saphenous vein were concluded in it. Diverted the flap to the defective area. Following the above-mentioned method, six distally based neurocutaneous saphenous island flaps were used to repair the soft tissue defect in lower limb. Five cases were survived completely; distal part of flap was necrosis partly in one case because of vein drainage disturbance, but the subcutaneous tissue under the necrosis was alive and healed by skin graft. The results were satisfactory after 6 to 19 months' follow-up.Argumentation: The blood supply of the skin , shallow fascia and deep fascia all came from the interior artery which get ramus after thrilling through the deep fascia. When there was special tissue such as nerve or vein, it also had ramus to these tissues. Taylor investigated the aterey supply and vein drainage in human body and anmiote body by anatomic study and concluded that each neurocutaneous had concomitant artery and vein drainage. The nerve went straightly but the vascularity of the nerve went flexuously. According to Taylor's conclusion, neurocutaneous had two types, one was axial type, which had a main artery accompanying the nerve, and the other was chain-type, which was formed by chain-linked longitudinal anastomoses, and the latter type was more usual than the fore type. Bertelli carried on an investigation into the interior and exterior nutrition artery of the neurocutaneous by microscopic study and gave the concept of paraneural ves...
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