Free Vascularized Lateral Femoral Cutaneous Nerve Graft with Anterolateral Thigh Flap for Reconstruction of Facial Nerve Defects

ABSTRACT

Wide resection of a malignant tumor in the parotid gland often results in loss of a long segment of facial nerve, as well as a soft-tissue defect. With conventional nerve grafts, functional recovery of the facial nerve is poor in cases with risk factors that might inhibit nerve regeneration, such as a history of irradiation and a recipient bed scarred from previous operations. For such cases, a vascularized nerve graft is reported to be more effective than a nonvascularized nerve graft. This paper describes the first successful use of a free vascularized lateral femoral cutaneous nerve graft combined with an anterolateral thigh flap to repair the facial nerve and a soft-tissue defect. This method is technically simple, has minimal donor-site morbidity, and typically results in successful nerve recovery.

KEYWORDS

Vascularized nerve graft - anterolateral thigh flap - facial nerve repair

REFERENCES

• 1 Baker D C, Conley J. Facial nerve grafting: a thirty year retrospective review.  Clin Plast Surg. 1979;  6 343-360
• 2 Kimata Y, Sakuraba M, Hishinuma S, Ebihara S, Hayashi R, Asakage T. Free vascularized nerve grafting for immediate facial nerve reconstruction.  Laryngoscope. 2005;  115 331-336
• 3 Koshima I, Yamamoto H, Moriguchi T, Kawada S, Ono Y. Combined anteroposterior tibial perforator-based flap with a vascularized deep peroneal nerve for repair of facial defect.  Ann Plast Surg. 1994;  33 421-425
• 4 Taylor G I, Ham F J. The free vascularized nerve graft. A further experimental and clinical application of microvascular techniques.  Plast Reconstr Surg. 1976;  57 413-426
• 5 Hasegawa T, Nakamura S, Manabe T, Mikawa Y. Vascularized nerve grafts for the treatment of large nerve gap after severe trauma to an upper extremity.  Arch Orthop Trauma Surg. 2004;  124 209-213
• 6 Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Kawai A. Vascularized femoral nerve graft with anterolateral thigh true perforator flap for massive defects after cancer ablation in the upper arm.  J Reconstr Microsurg. 2003;  19 299-302
• 7 Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S. New one-stage nerve pedicle grafting technique using the great auricular nerve for reconstruction of facial nerve defects.  J Reconstr Microsurg. 2004;  20 357-361
• 8 House J W. Facial nerve grading systems.  Laryngoscope. 1983;  93 1056-1069
• 9 Yanagihara N. On standardised documentation of facial palsy.  J Otolaryngol (Japan). 1977;  80 799-805
• 10 Koshima I, Harii K. Experimental study of vascularized nerve grafts: multifactorial analyses of axonal regeneration of nerves transplanted into an acute burn wound.  J Hand Surg Am. 1985;  10 64-72
• 11 Doi K, Tamaru K, Sakai K, Kuwata N, Kurafuji Y, Kawai S. A comparison of vascularized and conventional sural nerve grafts.  J Hand Surg Am. 1992;  17 670-676