| Objective: To explore the operation technique of using Distally-based saphenous neurocutaneous flap to treat the soft tissue defect and bone revealed in the lower limb and foot-ankle and investigate the advantages and disadvantages between them. To summarize the experience and according to the regularity of lower limb blood supply, consummate the modus operandi of cutting and using Distally-based saphenous neurocutaneous flap gradually, elevate the functional effect of the soft tissue defect and bone revealed in the lower limb and foot-ankle, enlarge the the application scope of flap and reduce the operation complication.Methods: collecting 21 cases which are using Distally-based saphenous neurocutaneous flap to treat the soft tissue defect and bone revealed in the lower limb between 2001 and 2008. Register the age,gener,the reason of injury,depth and area of soft tissue defect place,the area of cutting flap,the treatment of great saphenous vein and saphenous nerve,anastomosis condition of nervus cutaneus,contrivance and displace of pedicle and follow-up visit of the flap.analyze the correlation factor's influence on the take of flap,patient's feeling,function and appearance.reading pertinent literature to explore the improvement method on operation and announcements.Results: Using 21 cases of clinical application,in which 14 cases were males and 7 cases are females.The oldest is 56 years ,and the youngest is 28 years, mean age is 32 years.the biggest flap is 26cm×12 cm.the lesion place is located at heel,dorsum of foot,lateral malleolus and lateral part of lower limb.9 cases's great saphenous vein are ligated at the pedicle of flap, 2 cases's great saphenous vein are anastomosed with neurocutaneous flap of recipient site. In all cases,15 cases are steno-pedicle flaps ,6 cases are low swivel flaps,3 cares flaps are cutting with partly gastrocnemius or soleus,3 cases flaps are designed with crossing leg saphenous nerve vasa vasorum. flaps were mostly survived.only 4 flap's capillary are engorged slowly, the flaps are purple,and we can see blisters on them.3 cases are healed through decreased tension,raised lower limbs,and used drugs which can relax capillary.one flap's distal end is dead,but through dermatoplasty,this flap is healed.Conclusion: Because of the advantages of saphenous neurocutaneous flap as the reliable blood supply, lesser injuries for donor area,simple procedure and reconstruction of sensation, it received extensive solicitude both on anatomic and clinic study.but they also had some disadvantages as part feeling lost,bed venous return, neuroma and the recipient area maybe clumsy .We improved the saphenous neurocutaneous flap as follow :we designed the pedicle like Pear shape, in order to improve the venous return, which is to ligate the higher tension great saphenous vein; we designed the saphenous neurocutaneous flap with thin muscle, in order to eliminate the dead space and increase the resistance infection; we gravitate down the swivel of flap, in order to enlarge the repairing range; we anastomosed the saphenous vein with neurocutaneous flap of recipient site, in order to restitute the feeling; we designed the leg- across flap, in order to repair the severely impaired cases. We apply the improved saphenous neurocutaneous flap to enlarge the repairing range, decrease the operation complication, and icrease the satisfaction with functional rehabilitation of flap. All in all ,we believe following the development of flap surgery, distally-based saphenous neurocutaneous flap would be the best way to treat the soft tissue defect and bone revealed in the lower limb and foot-ankle.
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