Obturator Nerve Split for Gracilis Free-flap Double Reinnervation in Facial Paralysis

Abstract

Summary: The use of a double-powered free muscle transfer for facial reanimation has been reported by several authors with different types of nerve coaptation. A new nerve coaptation strategy is presented herein. We performed a 1-stage double-powered free gracilis muscle flap transfer in a patient with long-standing facial paralysis by splitting the obturator nerve and anastomosing the 2 free ends to the contralateral facial nerve (through a sural graft) and to the masseteric nerve. Voluntary movement of the transferred muscle with teeth clenching was observed at 6 months after the operation and a symmetric smile with bilateral elevation of the mouth angle at 10 months. Our limited experience suggests that in case of a large cross-section of the obturator nerve, the latter can be split and sutured to the ipsilateral masseteric nerve and to the contralateral facial nerve with a sural graft by double end-to-end anastomosis.

Extended and unusual indications in jaw reconstruction with the fibula flap: An overview based on our 30-year experience

“…To overcome these limitations, in our hospital the surgical team include a senior consultant, a surgeon without great experience and a resident. Surgeries are performed with traditional techniques [ [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] ] and innovative methods [ [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] ] according to characteristics of the patient. An accurate selection of the case [ 54 ] is the key for successful application of new methods in terms of cost-effectiveness.…”

Upper limb traumatic injuries: A concise overview of reconstructive options

“…Of note, the surgical background can significantly interfere with the surgeon's choices in traumatic emergencies as well as in elective procedures both in hand and plastic surgery [ 37 ]. Different surgical aspects have to be taken into considerations when facing with the patient: detailed knowledge of the topic and all surgical solutions [ 38 ]; technical possibilities according to hospital class (hub or spoke center) and epidemiologic challenges such as emerging COVID-19 pandemic [ [39] , [40] , [41] , [42] ]; required instruments to perform microsurgery [ [43] , [44] , [45] , [46] , [47] ]; use of new technologies, innovative surgical methods and unconventional devices [ [48] , [49] , [50] , [51] , [52] ]; possibility to refer to skilled consultants; possibility to work in multi-equip with different specialists [ [53] , [54] , [55] , [56] , [57] , [58] ]; selection of high-risk surgical wound complications patients throughout available scores [ 59 , 60 ]; the help of skilled health professionals able to early detect possible complications and promptly start proper care and close follow-up [ 61 , 62 ]. …”

Donors for nerve transplantation in craniofacial soft tissue injuries

“…It passes through the deep fascia and descends laterally to the Achilles tendon before advancing to the lateral malleolus and the distal side of the calcaneus ( Im et al, 2022 ). In craniofacial nerve transplantation, sural nerves are often used to restore sensory disturbances and malocclusions in the mandibular region as a result of inferior alveolar nerve (IAN) defects caused by tumor resection or trauma ( LaBanc et al, 1987 ; DeLeonibus et al, 2017 ) and facial paralysis caused by facial nerve injury ( Biglioli et al, 2018 ; Jeong et al, 2018 ; Baccarani et al, 2019 ; Rashid et al, 2019 ; Yoshioka, 2020 ; Chang et al, 2021 ; Sakuma et al, 2021 ). Traditionally, end-to-end suturing of the sural nerve with the nerve stump via interposition transplantation has been a common method for repairing nerve defects ( Rashid et al, 2019 ; Matos Cruz and De Jesus, 2022 ).…”