Facial functional outcomes analysis after reconstruction by vascularized thoracodorsal nerve free flap following radical parotidectomy with facial nerve sacrifice

Bedarida, Vincent; Qassemyar, Q.; Temam, Stéphane; Janot, F.; Kolb, F.

doi:10.1002/hed.26076

Cited by 16 publications

(16 citation statements)

References 40 publications

(54 reference statements)

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“…Preliminary results on FN recovery in a portion of the current sample underwent SD-VN flap were previously reported, 8 showing satisfactory outcomes.…”

Section: Discussionmentioning

confidence: 63%

“…Preliminary results on FN recovery in a portion of the current sample (eight patients) were previously reported showing satisfactory outcomes. 8 First sign of mobility occurred from 3 to 12 months (mean, 6.1) after surgery. Evaluation of facial recovery using the House-Brackmann 18 classification showed a grade IV in six patients and a grade III in two patients.…”

Section: Cosmetic Resultsmentioning

confidence: 99%

“…This flap is based on the subscapular pedicle and uses the highly versatile scapulodorsal donor site. 8 It allows the surgeon to raise the soft and hard tissues necessary to restore the volumetric defect along with harvesting the thoracodorsal motor nerve as a vascularized nerve graft. The ability to incorporate all of the components necessary for reconstruction makes the scapulodorsal vascularized nerve (SDVN) flap, an ideal flap for these patients.…”

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confidence: 99%

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Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap

Mangialardi

Honart

Qassemyar³

et al. 2020

J Reconstr Microsurg

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Background Cancer involving the parotid gland region may originates from parotid parenchyma itself or from locoregional organs and in rare cases, the facial nerve (FN) has to be sacrificed during tumor resection. In these cases, cancer extension often goes beyond the parotid compartment and requires extensive local resection responsible for complex multitissular defects. The goals of reconstruction may be summarized in the following two components: (1) restoration of the volumetric tissue defect and (2) FN reconstruction. The aim of this study is to describe our surgical technique and our cosmetic results using the chimeric scapulodorsal vascularized nerve (SDVN) flap to reconstruct extensive maxillofacial defects associated with FN sacrifice. Methods All patients undergone an extensive maxillofacial resection with FN sacrifice and primarily reconstructed with a SDVN flap were included. We classified the maxillofacial defects into six groups based on the type of resection. Intraoperative data including flap composition, topography of FN injury, length of nerve gap, and number of nervous anastomosis were recorded. Results Twenty-nine patients were included. Mean follow-up was 38.7 months. The harvested flaps included the SDVN combined with different components according to the defect group. A satisfactory volumetric restoration was obtained in 93% of cases. The mean number of distal nervous anastomosis was 4.5. The length of the vascularized grafted nerve ranged from 7 to 10 cm. Conclusion This is largest series presented in literature on primary FN reconstruction utilizing a vascularized nerve graft. We believe that the chimeric SDVN flap should be highly considered for these cases due to its versatility. The surgeon is able to use single donor site available soft and hard tissues components along with a vascular motor nerve graft, which offers a great length and number of distal branches, and easily matches with the extracranial FN trunk and its peripheral ramifications.

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“…Preliminary results on FN recovery in a portion of the current sample underwent SD-VN flap were previously reported, 8 showing satisfactory outcomes.…”

Section: Discussionmentioning

confidence: 63%

Section: Cosmetic Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap

Mangialardi

Honart

Qassemyar³

et al. 2020

J Reconstr Microsurg

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“…The functional results were evaluated in eight patients, with the eFace application 25 and the House Brackman scale (HBS). According to the HBS, six patients had a score of IV, and two had a score of III 26 . Recovery seems better for eyelid motor skills, five of the eight patients had a score of II (Video S3).…”

Section: Discussionmentioning

confidence: 98%

Thoracodorsal artery perforator free flap with vascularized thoracodorsal nerve for head and neck reconstruction following radical parotidectomy with facial nerve sacrifice: Step‐by‐step surgical technique video

et al. 2021

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Oncological surgery of the parotid region sometimes requires the sacrifice of the facial nerve (parotid cancers, extensive skin cancers of the face, soft tissue sarcomas). The sacrificed portion of nerve can be reconstructed by a vascularized nerve graft, especially if the patient must undergo radiotherapy after surgery. In those cases, the facial nerve sacrifice is associated to an important loss of substance from the parotid region (skin, masseter, parotid, and sometimes jaw). Chimeric flap permit the reconstruction at the same time of the external skin, soft tissues for the volume (fat or muscle), nerve, and bone (ramus and angular part of the mandible). An other option was to raise two flaps but it increased the risk of failure (time of surgery, number of anastomosis, etc.). Reconstruction with a chimeric flap appears to be an ideal choice. Based on these observations, we offer our patients at the Gustave Roussy Institute (Villejuif, France) a thoracodorsal artery perforator (TDAP) free flap including the motor nerve of the latissimus dorsi and vascularized by the thoraco‐dorsal pedicle, thus allowing reconstruction in a single surgery. The surgical technique is explained with a step‐by‐step video. Functional outcomes are also shown in the video. The TDAP or chimeric scapulo‐dorsal flap with vascularized nerve has many advantages in the facial reanimation of patients suffering from parotid region cancers. This video article explains surgical steps for other teams.

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“… 18 19 20 Motor nerves as VNT have also been described either alone or as a part of composite free tissue transfers for facial defects. 21 22 …”

Section: Discussionmentioning

confidence: 99%

Facial Nerve Reconstruction with Free Vascularized Composite Nerve Flap from Intrapetrous Portion to Terminal Branches—Case Report

Cavadas

Bakliñska²

2021

Indian J Plast Surg

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Facial functional outcomes analysis after reconstruction by vascularized thoracodorsal nerve free flap following radical parotidectomy with facial nerve sacrifice

Abstract: Background: Parotid spread tumor may occasion wide defect with facial nerve sacrifice. We report our one time reconstruction experience of this defect using a thoracodorsal artery perforator and nerve flap (TAPN).

Cited by 16 publications

References 40 publications

Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap

Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap

Thoracodorsal artery perforator free flap with vascularized thoracodorsal nerve for head and neck reconstruction following radical parotidectomy with facial nerve sacrifice: Step‐by‐step surgical technique video

Facial Nerve Reconstruction with Free Vascularized Composite Nerve Flap from Intrapetrous Portion to Terminal Branches—Case Report

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