Two consecutive patients aged 50 and 65 years underwnt en bloc resection of sarcoma of the upper arm including the brachial artery and vein and median nerve. The pathohistological diagnoses were myxoid liposarcoma and epithelioid hemangioendothelioma. The lengths of the defects were 13 and 12 cm. Resected vessels and median nerve defects were reconstructed using great saphenous vein grafts and vascularized sural nerve grafts, respectively. The nerves were harvested at twice the length of the defects along with the small saphenous vein and surrounding adipose tissue, including the venous network. A “flow-through” venous free sural nerve graft ( VnNG ) was then applied and folded at the midpoint to obtain the nerve graft thickness. Finally, the sural vein was anastomosed to the cutaneous vein to make a “flow-through” venous flap. The postoperative periods were 122 months and 105 months. Although anterior interosseous nerve palsy was still present in the first case, forearm muscle strength in pronation was graded as 4 on the manual muscle testing scale. This paradoxical recovery seemed to be the result of late occlusion of the arterial graft. Tinel’s sign was present in both patients, and nerves were regenerating at rates of 2.06 and 2.3 cm/month. Moving two-point discrimination was found to vary between 0 and 6 mm. Recovery was graded as blue ( good ) to purple ( fair ) on the Semmes-Weinstein test. These results suggest that the sural nerve is the preferred conduit for VnNG of long peripheral nerve defects in the extremities.
