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Facial Nerve Revascularization Strategies in Facial Restoration

Facial transplants represent the current exemplar in the reconstruction of severely damaged faces, whereas conventional free flap reconstruction has its limitations in restoring both function and surface cover. METHODS: In a retrospective study over 6 years (2014–2020), 5 cases (n = 5) of vasculariz...

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Autores principales: Khajuria, Ankur, Bisase, Brian, Norris, Paul, Dhanda, Jag, Koshima, Isao, Nduka, Charles, Kannan, Ruben Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8758059/
https://www.ncbi.nlm.nih.gov/pubmed/35047325
http://dx.doi.org/10.1097/GOX.0000000000004038
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author Khajuria, Ankur
Bisase, Brian
Norris, Paul
Dhanda, Jag
Koshima, Isao
Nduka, Charles
Kannan, Ruben Y.
author_facet Khajuria, Ankur
Bisase, Brian
Norris, Paul
Dhanda, Jag
Koshima, Isao
Nduka, Charles
Kannan, Ruben Y.
author_sort Khajuria, Ankur
collection PubMed
description Facial transplants represent the current exemplar in the reconstruction of severely damaged faces, whereas conventional free flap reconstruction has its limitations in restoring both function and surface cover. METHODS: In a retrospective study over 6 years (2014–2020), 5 cases (n = 5) of vascularized nerve flaps (VNFs) were performed by our team. These involved three acute and two late reconstructions. The mean age was 41 years with a maximum of 6-year follow-up. 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. Postoperative function was evaluated using the validated Sunnybrook and Terzis scores for facial nerve palsy; masticatory function was assessed using dental impression studies. RESULTS: There was a 100% flap survival rate, with no instances of flap necrosis and only one complication: hematoma at 24 hours postoperative. Sunnybrook and Terzis scores showed a statistically significant improvement postoperatively, indicating both improved repose and facial expressions (paired student t test, P < 0.05). Given that each VNF was specifically customized for a particular patient, each type of VNF in this cohort was unique, thereby illustrating each type succinctly. CONCLUSIONS: VNFs are separate entities from standard free flaps, as they require extensive preoperative 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.
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spelling pubmed-87580592022-01-18 Facial Nerve Revascularization Strategies in Facial Restoration Khajuria, Ankur Bisase, Brian Norris, Paul Dhanda, Jag Koshima, Isao Nduka, Charles Kannan, Ruben Y. Plast Reconstr Surg Glob Open Reconstructive Facial transplants represent the current exemplar in the reconstruction of severely damaged faces, whereas conventional free flap reconstruction has its limitations in restoring both function and surface cover. METHODS: In a retrospective study over 6 years (2014–2020), 5 cases (n = 5) of vascularized nerve flaps (VNFs) were performed by our team. These involved three acute and two late reconstructions. The mean age was 41 years with a maximum of 6-year follow-up. 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. Postoperative function was evaluated using the validated Sunnybrook and Terzis scores for facial nerve palsy; masticatory function was assessed using dental impression studies. RESULTS: There was a 100% flap survival rate, with no instances of flap necrosis and only one complication: hematoma at 24 hours postoperative. Sunnybrook and Terzis scores showed a statistically significant improvement postoperatively, indicating both improved repose and facial expressions (paired student t test, P < 0.05). Given that each VNF was specifically customized for a particular patient, each type of VNF in this cohort was unique, thereby illustrating each type succinctly. CONCLUSIONS: VNFs are separate entities from standard free flaps, as they require extensive preoperative 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. Lippincott Williams & Wilkins 2022-01-13 /pmc/articles/PMC8758059/ /pubmed/35047325 http://dx.doi.org/10.1097/GOX.0000000000004038 Text en Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Reconstructive
Khajuria, Ankur
Bisase, Brian
Norris, Paul
Dhanda, Jag
Koshima, Isao
Nduka, Charles
Kannan, Ruben Y.
Facial Nerve Revascularization Strategies in Facial Restoration
title Facial Nerve Revascularization Strategies in Facial Restoration
title_full Facial Nerve Revascularization Strategies in Facial Restoration
title_fullStr Facial Nerve Revascularization Strategies in Facial Restoration
title_full_unstemmed Facial Nerve Revascularization Strategies in Facial Restoration
title_short Facial Nerve Revascularization Strategies in Facial Restoration
title_sort facial nerve revascularization strategies in facial restoration
topic Reconstructive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8758059/
https://www.ncbi.nlm.nih.gov/pubmed/35047325
http://dx.doi.org/10.1097/GOX.0000000000004038
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