Targeted Nerve Repair With Reverse Vascularized Nerve Flap Combined With Sural Nerve Grafts for a Long Sciatic Nerve Gap

ABSTRACT: Nerve grafting for large sciatic nerve gap has been associated with low functional recovery rates and unsatisfactory outcomes. The authors present a case of an 18-year-old male with successful surgical management for a 9-cm sciatic nerve gap presenting with complete loss of right ankle and toe movements (Medical Research Council M0) as well as right lower limb sensory deficits (S0). Nerve reconstruction was performed using a novel surgical technique, the reverse vascularized nerve flaps. The medial sural cutaneous and superficial peroneal nerves were selected as donor nerves due to their limited impact on overall function. At 3 years postoperation, the patient demonstrated significant recovery, with strengthened ankle plantar flexion (M4) and dorsiflexion (M3), along with normal sole sensation (S3). The reverse vascularized nerve flap enhances the regeneration potential of grafted axons while reducing operation time. Prioritizing key functions such as ankle dorsiflexion, plantarflexion, and plantar sensation increases efficiency in sciatic nerve reconstruction.