Facial nerve revascularization strategies in facial restoration
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Facial transplants represent the current gold standard in the reconstruction of severely damaged faces while conventional free flap reconstruction has its limitations in restoring both function and surface cover.
Methods
In a retrospective study over seven years (2014-20) in our institution, six cases (n = 6) of vascularized nerve flaps (VNFs) were performed by our team. These involved three acute and two late reconstructions. The mean age in our cohort was 41 years with a maximum six-year follow-up. Using a specific classification system for VNFs, to objectify the different permutations and combinations, we categorized composite, chimeric and hybrid VNFs into types I, IIa-c and III, each with a unique characteristic. Post-op facial function was evaluated using the Sunnybrook and Terzis scores for facial nerve palsy while masticatory function was assessed using dental impression studies.
Results
There was a 100% flap survival rate with no instances of flap necrosis with only one complication; a haematoma at 24 hours post-op. Sunnybrook and Terzis scores for these patients showed a statistically significant improvement post-op, indicating both improved repose and facial expressions as a whole (paired student’s t-test, p < 0.05). Given that each VNFS was specifically customized for a particular patient, each type of VNFS in this cohort was unique, thereby illustrating each type succinctly.
Conclusion
VNFs are separate entities from standard free flaps as it requires extensive pre-op planning to allow the deconstructing of composite blocks of tissue into separate vascularized entities and amalgamating them into a new conglomerate. This allows VNFs to fill a niche area in facial reconstructive surgery between face transplants and conventional free tissue transfers, with enormous potential.
Facial transplants represent the current gold standard in the reconstruction of severely damaged faces while conventional free flap reconstruction has its limitations in restoring both function and surface cover.
Methods
In a retrospective study over seven years (2014-20) in our institution, six cases (n = 6) of vascularized nerve flaps (VNFs) were performed by our team. These involved three acute and two late reconstructions. The mean age in our cohort was 41 years with a maximum six-year follow-up. Using a specific classification system for VNFs, to objectify the different permutations and combinations, we categorized composite, chimeric and hybrid VNFs into types I, IIa-c and III, each with a unique characteristic. Post-op facial function was evaluated using the Sunnybrook and Terzis scores for facial nerve palsy while masticatory function was assessed using dental impression studies.
Results
There was a 100% flap survival rate with no instances of flap necrosis with only one complication; a haematoma at 24 hours post-op. Sunnybrook and Terzis scores for these patients showed a statistically significant improvement post-op, indicating both improved repose and facial expressions as a whole (paired student’s t-test, p < 0.05). Given that each VNFS was specifically customized for a particular patient, each type of VNFS in this cohort was unique, thereby illustrating each type succinctly.
Conclusion
VNFs are separate entities from standard free flaps as it requires extensive pre-op planning to allow the deconstructing of composite blocks of tissue into separate vascularized entities and amalgamating them into a new conglomerate. This allows VNFs to fill a niche area in facial reconstructive surgery between face transplants and conventional free tissue transfers, with enormous potential.
Date Issued
2022-01
Date Acceptance
2021-11-09
Citation
Plastic and Reconstructive Surgery Global Open, 2022, 10 (1), pp.1-6
ISSN
2169-7574
Publisher
Lippincott, Williams & Wilkins
Start Page
1
End Page
6
Journal / Book Title
Plastic and Reconstructive Surgery Global Open
Volume
10
Issue
1
Copyright Statement
© 2022 The Authors. Published by Wolters Kluwer Health,
Inc. on behalf of The American Society of Plastic Surgeons. This is
an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original
work is properly cited
Inc. on behalf of The American Society of Plastic Surgeons. This is
an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original
work is properly cited
License URL
Identifier
https://journals.lww.com/prsgo/Fulltext/2022/01000/Facial_Nerve_Revascularization_Strategies_in.20.aspx
Publication Status
Published
Date Publish Online
2022-01