Anatomical variations of the sensory nerves to the fibular osteocutaneous flap.

OBJECTIVE To describe the anatomical relationship of the sural sensory nerve complex to the posterior crural intermuscular septum (PS), the key anatomical structure for the osteoseptocutaneous fibula skin paddle. DESIGN Anatomical study. SUBJECTS Twenty-two legs from 11 cadavers (7 females and 4 males). RESULTS The lateral sural cutaneous (LSC) nerve, present in 20 of 22 legs, divides into lateral and medial branches near the head of the fibula. The LSC nerve and its medial branch course away from the PS, whereas the lateral branch tends to course toward the PS. The lateral branch courses nearest to the PS at a median distance of between 4 cm proximally and 3 cm distally. The medial branch of the LSC nerve terminates approximately in the middle of the leg, and the lateral branch of the LSC nerve terminates within 7 cm below the head of the fibula. The peroneal communicating branch is thicker than the LSC nerves; however, it is further from the PS in the upper leg. CONCLUSIONS The LSC nerve is the most consistent and accessible donor sensory nerve in the posterior leg for harvest with the osteoseptocutaneous fibula free flap. Results of this study will assist the surgeon in harvesting a sensory nerve with the osteoseptocutaneous fibula free flap, bringing this potentially sensate flap into more common use. Arch Facial Plast Surg. 2000;2:252-255