J Reconstr Microsurg 2010; 26(9): 577-582
DOI: 10.1055/s-0030-1263288
© Thieme Medical Publishers

Facial Nerve Reconstruction Using a Vascularized Lateral Femoral Cutaneous Nerve Graft Based on the Superficial Circumflex Iliac Artery System: An Application of the Inferolateral Extension of the Groin Flap

Katsuhiko Kashiwa1 , Seiichiro Kobayashi1 , Wakako Nasu1 , Takashi Kuroda1 , Hirofumi Higuchi1
  • 1Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University, Faculty of Medicine, Uchimaru, Morioka, Japan
Further Information

Publication History

Publication Date:
09 August 2010 (online)

ABSTRACT

The use of an inferolateral extension technique of a groin flap has previously been reported. This technique involves harvesting an extended portion from the anterolateral thigh, including the lateral femoral cutaneous nerve (LFCN) and its accompanying vessels, attached to a groin flap via communications between the LFCN-accompanying vessels and the superficial circumflex iliac artery (SCIA) system. In this study, we used this technique involving a vascularized LFCN combined with a groin flap to reconstruct a facial nerve defect. The patient was a 58-year-old man with a salivary duct carcinoma in the left parotid gland. Tumor ablation resulted in a defect of the skin and soft tissue including all branches of the facial nerve. A free groin flap was harvested based on the SCIA system, composed of the LFCN and a small monitoring flap, which were nourished by the LFCN-accompanying vessels and by communication with the SCIA system. The LFCN was transplanted into the gaps in the facial nerve branches as a cable graft, and the skin flap was used to cover and fill the soft tissue defect. The postoperative course was uneventful and satisfactory facial animation was obtained. This represents a possible technique for nerve reconstruction using a vascularized nerve graft.

REFERENCES

  • 1 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
  • 2 Gullane P J, Havas T J. Facial nerve grafts: effects of postoperative irradiation.  J Otolaryngol. 1987;  16 112-115
  • 3 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
  • 4 Mackinnon S E, Kelly L, Hunter D A. Comparison of regeneration across a vascularized versus conventional nerve graft: case report.  Microsurgery. 1988;  9 226-234
  • 5 Shibata M, Tsai T M, Firrell J, Breidenbach W C. Experimental comparison of vascularized and nonvascularized nerve grafting.  J Hand Surg [Am]. 1988;  13 358-365
  • 6 Kobayashi S, Sekiguchi J, Harii K. Free or pedicled vascularized sural nerve graft to lower leg [in Japanese].  Jpn J Plast Reconstr Surg. 1988;  8 49-59
  • 7 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
  • 8 Schultes G, Gaggl A, Kleinert R, Kärcher H. Vascularized versus non-vascularized nerve transfers: histologic study in rats.  J Reconstr Microsurg. 2001;  17 637-642
  • 9 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
  • 10 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
  • 11 Iida T, Nakagawa M, Asano T, Fukushima C, Tachi K. Free vascularized lateral femoral cutaneous nerve graft with anterolateral thigh flap for reconstruction of facial nerve defects.  J Reconstr Microsurg. 2006;  22 343-348
  • 12 Kashiwa K, Kobayashi S, Saito A, Honda T. Inferior extension of the groin flap based on the descending branch of the superficial circumflex iliac artery.  J Reconstr Microsurg. 2002;  18 653-658
  • 13 Kashiwa K, Kobayashi S, Ogino K, Kashiwaya G, Higuchi H. Inferolateral extension of the groin flap based on the artery accompanying the lateral femoral cutaneous nerve.  J Reconstr Microsurg. 2009;  25 181-189
  • 14 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
  • 15 Urken M L, Weinberg H, Vickery C, Biller H F. The neurofasciocutaneous radial forearm flap in head and neck reconstruction: a preliminary report.  Laryngoscope. 1990;  100(2 Pt 1) 161-173
  • 16 Kashiwa K, Kobayashi S, Hayashi M, Honda T, Nasu W. Gastrocnemius perforating artery flap including vascularized sural nerve.  J Reconstr Microsurg. 2003;  19 443-450
  • 17 Kashiwa K, Kobayashi S, Tono H, Ogino K, Kimura H. Operative technique to harvest an arterial flap from the posterolateral calf region: how can we elevate a lateral gastrocnemius perforating artery flap safely?.  J Reconstr Microsurg. 2008;  24 57-66
  • 18 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
  • 19 Koshima I, Okumoto K, Umeda N, Moriguchi T, Ishii R, Nakayama Y. Free vascularized deep peroneal nerve grafts.  J Reconstr Microsurg. 1996;  12 131-141
  • 20 Koshima I, Narushima M, Mihara M, Uchida G, Nakagawa M. Fascicular turnover flap for nerve gaps.  J Plast Reconstr Aesthet Surg. 2010;  63 1008-1014

Katsuhiko KashiwaM.D. 

Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Iwate Medical University

19-1 Uchimaru, Morioka 020-8505, Japan

Email: kkashiwa@iwate-med.ac.jp

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