Hatchell Alexandra C, Chandarana Shamir P, Matthews Jennifer L, McKenzie C David, Matthews T Wayne, Hart Robert D, Dort Joseph C, Schrag Christiaan H, Harrop A Robertson
Section of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Division of Plastic Surgery, Department of Surgery, Queen's University, Kingston, Ontario, Canada.
Plast Reconstr Surg Glob Open. 2021 Jan 22;9(1):e3374. doi: 10.1097/GOX.0000000000003374. eCollection 2021 Jan.
Few studies have evaluated vascularized nerve grafts (VNGs) for facial nerve (CNVII) reconstruction. We sought to evaluate long-term outcomes for CNVII recovery following reconstruction with VNGs. A retrospective review of all patients at a tertiary centre who underwent radical parotidectomy and immediate CNVII reconstruction with VNGs was performed (January 2009-December 2019). Preoperative demographics, perioperative factors (flap type, source of VNGs), and postoperative factors [complications, adjuvant therapy, revisionary procedures, length of follow-up, and CNVII function via the House-Brackmann scale (HB)] were collected. Data were summarized qualitatively. Twelve patients (M = 53 ± 18 years) with a mean follow-up of 33 (± 23) months were included. Six patients underwent reconstruction with a radial forearm flap and dorsal sensory branches of the radial nerve. Six patients underwent reconstruction with an anterolateral thigh flap and only deep motor branches of the femoral nerve to the vastus lateralis (n = 4) or combined with the lateral femoral cutaneous nerve (n = 2). Two patients regained nearly normal function (HB = 2). Eight patients regained at least resting symmetry (HB = 3 for n = 7; HB = 4 for n = 1). One patient regained a flicker of movement (HB = 5). One patient did not regain function (HB = 6). Six patients had static revision procedures to improve symmetry. Five patients had disease recurrence; 3 died from their disease. VNGs offer a practical and viable addition to the CNVII reconstruction strategy, and result in good functional recovery with acceptable donor site deficits. The associated adipofascial component of these flaps can also augment the soft tissue defect left after tumor ablation.
很少有研究评估血管化神经移植物（VNG）用于面神经（CNVII）重建的效果。我们试图评估VNG重建后CNVII恢复的长期结果。对一家三级中心在2009年1月至2019年12月期间接受根治性腮腺切除术并立即用VNG进行CNVII重建的所有患者进行了回顾性研究。收集了术前人口统计学资料、围手术期因素（皮瓣类型、VNG来源）和术后因素[并发症、辅助治疗、修复手术、随访时间以及通过House-Brackmann量表（HB）评估的CNVII功能]。对数据进行了定性总结。纳入了12例患者（男性，53±18岁），平均随访33（±23）个月。6例患者采用桡侧前臂皮瓣和桡神经背侧感觉支进行重建。6例患者采用股前外侧皮瓣，仅使用股神经至股外侧肌的深部运动支（n = 4）或联合股外侧皮神经（n = 2）进行重建。2例患者恢复了几乎正常的功能（HB = 2）。8例患者至少恢复了静息对称性（7例HB = 3；1例HB = 4）。1例患者恢复了轻微运动（HB = 5）。1例患者未恢复功能（HB = 6）。6例患者进行了静态修复手术以改善对称性。5例患者疾病复发；3例患者死于疾病。VNG为CNVII重建策略提供了一种实用且可行的补充，可实现良好的功能恢复，且供区缺损可接受。这些皮瓣相关的脂肪筋膜成分还可填补肿瘤切除后留下的软组织缺损。
