Abstract
Background: A new method “fascicular turn over method” using vascularized fascicular flap was used for repairing nerve gaps. Following the recent development of supramicrosurgical techniques appropriate for the microanatomy of peripheral nerves, a new method of intraoral “cross-face nerve transfer” was successfully used for repairing trigeminal nerve palsy.
Methods and Results: Four cases with digital and facial nerves gaps were repaired with fascicular turn over flap without any nerve graft. Three patients were digital nerve gaps (10–20 mm in length) and one patient was 3 cm facial nerve gap. The results of sensory recovery of digital nerve gap were 3.22–3.66 (Semmes-Weinstein values) and 6–12 mm (moving two point discriminations) at 6–16 months after surgery. Two cases of trigeminal nerve palsy were repaired with contralateral trigeminal nerve transfer without any nerve graft. Affected upper labial sensory recovery was 1.65–2.44 (Semmes-Weinstein values) and 15–30 mm (moving two-point discriminations) at 1 to 1½ years after surgery.
Conclusion: The advantages of this method are: No need for sacrificing a normal donor nerve, and short time operation. Digital nerve gaps can be repaired under a local anesthesia. The advantages of cross-face trigeminal nerve transfer are excellent nerve regeneration and the lack of donor site morbidity. It is a brief and simple operation in comparison to free nerve grafts. The disadvantage is a need for spermicrosurgical technique using 50 μm needle.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Taylor GI, Ham FJ. The free vascularized nerve graft. A further experimental and clinical application of microvascular techniques. Plast Reconstr Surg. 1976;57:413–25.
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.
Koshima I, Harii K. Experimental study of vascularized nerve grafts: morphometric study of axonal regeneration of nerves transplanted into silicone tubes. Ann Plast Surg. 1985;14:235–43.
Rose EH, Kowalski TA. Restration of sensibility to aesthetic scarred digits with free vascularized nerve grafts from the dorsum of the foot. J Hand Surg. 1985;10A:514–21.
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;17:670–6.
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;33:421–5.
Koshima I, Okumoto K, Umeda N, et al. Free vascularized deep peroneal nerve grafts. J Reconstr Microsurg. 1996;12:131–41.
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 Micosurg. 2003;19:299–302.
Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S. New one-stage nerve pedicle grafting technique using the great auriclar nerve for reconstruction of facial nerve defects. J Reconstr Microsurg. 2003;19:299–302.
Kimata Y, Sakuraba M, Hishinuma S, Ebihara S, Hayashi R, Asakage T. Free vascularized nerve grafting for immediate facial nerve reconstruction. Laryngoscope. 2005;115:331–6.
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;22:343–7.
Lundborg G. The intrinsic vascularization of human peripheral nerves: structural and functional aspect. J Hand Surg Am. 1979;4:34–41.
Koshima I, Nanba Y, Tsutsui T, Takahashi Y. Deep peroneal nerve transfer for established plantar sensory loss. J Reconstr Microsurg. 2003;19:451–4.
Disclosure
The authors of this paper have no financial interest nor any commercial association related to the information presented in this paper. There are no conflicts of interest or any funding sources that require disclosure.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Koshima, I. et al. (2021). Fascicular Turnover Flap for Facial Nerve Gaps and Nerve Transfer for Trigeminal Palsy. In: Tzou, CH.J., Rodríguez-Lorenzo, A. (eds) Facial Palsy. Springer, Cham. https://doi.org/10.1007/978-3-030-50784-8_36
Download citation
DOI: https://doi.org/10.1007/978-3-030-50784-8_36
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-50783-1
Online ISBN: 978-3-030-50784-8
eBook Packages: MedicineMedicine (R0)