For this reason, a clinically-relevant large animal nerve graft model for facial nerve regeneration research is needed. already built in. The sural nerve is one of the most commonly used donor nerves in autologous nerve grafting, because it serves a purely sensory function and can easily be harvested [ 9 ]. Demonstration of sural nerve graft to the buccal branch with end-to-end neurorrhaphy. J Reconstr Microsurg. The MSCN descended pararell to the short saphenous vein in the gastrocnemius fascia. Acellular nerve allografts in peripheral nerve regeneration: a comparative study. The nerve is released from the fascia needle, and the fascia needle is then passed from the contralateral lip incision, across the face of the maxilla, and out the incision where the nerve is now located. In an acute injury, nerve grafting provides regenerating fibers from the donor nerve on the normal side to reinnervate across the face to the similar recipient nerve on the paralyzed side. 2022 Apr;28(2):364-378. doi: 10.1089/ten.TEB.2020.0381. A 15-mm segment of the sural nerve was grafted with six-epineural suture techniques using 10-0 nylon to bridge the defect in the buccal branch of the ovine facial nerve with end-to-end neurorrhaphy under a surgical microscope. A sural nerve graft is then harvested subcutaneously from the desired leg in the usual fashion using a tendon stripper. 20 the medial sural nerve arises from the tibial nerve in the popliteal fossa (around 6 cm proximal to the fibular head) while the lateral sural nerve arises from the Facial nerve cable grafting using the sural nerve is a well-established procedure for the repair of facial nerve defects [ 8 ]. The surgical anatomy and the number of fascicles of the ovine sural nerve were similar of those reported in humans. This review summarizes the existing literature on facial nerve injury, regeneration, and reinnervation techniques with a focus on nerve transfer and its various options. After transection, the donor facial nerve is reflected posteriorly. On follow-up examinations 18 months after surgery,. Methods Per-oral cross-facial sural nerve graft for facial reanimation Thereafter, the MSCN joined with a communicating branch and formed the sural nerve in the fascia. Enkhbaatar P, et al. 3A,B). Undifferentiated and differentiated adipose-derived stem cells improve nerve regeneration in a rat model of facial nerve defect. A 17-year . All Rights Reserved The nerve is comprised of spinal nerve roots from S1 and S2. Briefly, a pre-auricular incision extending from 1.5cm posterior to the mandibular ramus to a submandibular point 2cm below the mandibular body was made in the right face of the sheep cadaver. Federal government websites often end in .gov or .mil. R.S.G., S.J., H.K.H. Gc (Lateral h.): Gastrocnemius lateral head. Effect of axonal load on the functional and aesthetic outcomes of the cross-facial nerve graft procedure for facial reanimation. A 1-stage double-powered free gracilis muscle flap transfer in a patient with long-standing facial paralysis is described herein by splitting the obturator nerve and anastomosing the 2 free ends to the facial nerve (through the sural graft) and to the masseteric nerve. Lee MC, Kim DH, Jeon YR, Rah DK, Lew DH, Choi EC, Lee WJ. If long nerve grafts are desired to span the entire face and unite the right and left facial nerves (cross face nerve graft) then both sural nerves may be utilized. The sural nerve is expendable and is not required for walking. Its power can be harnessed with great efficacy for the regeneration of the facial nerve. government site. Macrophage-Induced Blood Vessels Guide Schwann Cell-Mediated Regeneration of Peripheral Nerves. Methods Patients who underwent cable grafting from April 2007 to August 2011 were reviewed, in which a harvested branch of the sural nerve was grafted onto each facial nerve division. 2,3 In summary, the results of the present study show that the surgical anatomy and morphology of the ovine sural nerve are quite similar to those of humans, suggesting that an ovine sural nerve grafting model can be successfully used for research on facial nerve regeneration and reconstruction. The sural nerve ran posterior to the lateral malleolus in the subcutaneous tissue. The patient's postoperative course was uneventful. Journal of Plastic, Reconstructive & Aesthetic Surgery. wrote the manuscript. The modification of the conventional technique of Hypoglossal-Facial nerve anastomosis by means of sectioning one third of the hypoglossa nerve area does not lead to dysfunction of this nerve and the surgical results in terms of facial reanimation are satisfactory. Other nerves that we use are the one that provides feeling on the forearm by the elbow or even behind the ear. The other branch originated from the tibial nerve (Fig. The authors interposed a sural nerve graft to reinforce the facial nerve whose partial anatomical continuity had been preserved. Lee EI, Hurvitz KA, Evans GRD, Wirth GA. Cross-facial nerve graft: past and present. By clicking accept or continuing to use the site, you agree to the terms outlined in our. Matsuda K, et al. You may notice problems with The surgeon must select appropriate segmental branches of the contralateral facial nerve as donors, with the sural nerve serving as a cable graft. In this study, we have also developed a technique for grafting of a segment of sural nerve to the buccal branch of the facial nerve using end-to-end neurorrhaphy in cadaver sheep. and D.S.P. At 1-year follow-up, the patient showed MRC grade 4/5 strength with knee flexion and steady gait pattern with a left ankle-foot . Epub 2021 Apr 13. 2022 Oct;42(7):703-713. doi: 10.1002/micr.30890. Unilateral Multiple Facial Nerve Branch Reconstruction Using "End-to-side Loop Graft" Supercharged by Hypoglossal Nerve. In the posterior calf, the sural nerve emerges from between the two heads of the gastrocnemius muscle and runs with the small saphenous vein inferiorly to curve under the lateral malleolus. Three anesthetized sheep were used for nerve stimulation. 2008 Oct;24(7):519-23. Single-Incision endoscopic sural nerve harvest for cross face nerve grafting. Endoscopic harvest of sural nerve graft with balloon dissection. One branch, originating from the sciatic nerve, was located between the tibial and common fibular nerves. The sural nerve will course within the subcutaneous plane in the posterolateral leg. Nidus Wellness and Resilience Residents Foundation Directory. Harvesting of the sural nerve using a stripper. Tisseel is then used circumferentially at the neurrorhaphy site. In this study, we aimed to describe the surgical anatomy of the ovine sural nerve. Although the diameter of the donor (sural) nerve was smaller compared to the recipient (buccal) nerve, epineural suturing was performed easily without any tension (Fig. In: StatPearls [Internet]. Kim ED, Seo JT. FOIA Another limitation is that this study describes sural anatomy and histology only in the right side of the ovine leg. Nerve Graft Repair Procedure - NYC | Columbia Neurosurgery in New York City Nerve Graft Repair Make an Appointment Our team of dedicated access representatives is here to help you make an appointment with the specialists that you need. A rat study of the use of end-to-side peripheral nerve repair as a "babysitting" technique to reduce the deleterious effect of chronic denervation. PMC Facial muscle movement will not emerge until 9-12 months after the procedure (ie, the allotted time for axonal growth to cross the graft). (A) Schematic diagram of sural nerve graft. Management of Sural Nerve Neuromas with Targeted Muscle Rein - LWW The goal of peripheral nerve reconstruction with a nerve graft is to provide a scaffold that guides the regenerating axons towards the distal nerve stump and permits end-organ reinnervation. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. The decrease in operative time and the significant decrease in incision length compared with open techniques make it a logical choice for the facial reanimation surgeon ( Fig. Cross Facial Nerve Graft (CFNG) - Shai M. Rozen, M.D., F.A.C.S. The .gov means its official. All authors approved the final version of the manuscript. Cross Face Nerve Grafts for Facial Paralysis | Dr. Klebuc Houston, TX Autologous nerve grafts from sural nerve or the greater auricular nerve are commonly applied for IAN or LN repair, since they provide a good match for the number of fascicles . 1B). The lack of clinical studies using artificial nerves may be related to the fact that the nerves reconstructed with artificial nerves are less functional compared to that reconstructed with gold standard autologous nerve graft46. The lack of a clinically relevant animal models for research in facial nerve reconstruction is challenging. Ortiguela ME, Wood MB, Cahill DR. Anatomy of the sural nerve complex. Log In. Per-oral cross-facial sural nerve graft for facial reanimation Sural nerve graft harvest. The MSCN, tibial nerve, common fibular nerve, and sciatic nerve were identified between the biceps femoris and semimembranosus muscles (Fig. The other reason may be related to the lack of clinically relevant large animal models allowed to investigate the effects of artificial nerve conduits in comparison to autologous nerve grafts. 7). A sural nerve "loop" graft for total facial nerve reconstruction: a Publishers note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Interstingly, we also found that the number of myelinated fibers in the ovine buccal branch (4,768 430) was much higher than in humans (1,670, average age 72 years)30. Autologous sural nerve grafting with an end-to-end neurorrhaphy technique to bridge defects of the buccal branch is the gold standard of surgical treatment for facial nerve reconstruction1. Behse F. Morphometric studies on the human sural nerve. On the other hand, no innervation of leg muscles was observed after stimulation of the sural nerve or the MSCN. A timeout was performed and the correct patient and procedure were confirmed. Histological assessment. Its distal continuation via the lateral calcaneal and lateral dorsal cutaneous branches provides sensation to the posterolateral aspect of the foot. Functional Outcomes of Multiple Sural Nerve Grafts for Facial Nerve Defects after Tumor-Ablative Surgery. METHODS The authors retrospectively evaluated data from patients who had undergone cable graft interpositioning after nerve sacrifice during skull base tumor removal between June 1987 and May . Mahakkanukrauh P, Chomsung R. Anatomical variations of the sural nerve. Outcome Although the basis for this discrepancy is not known, we speculate the following: (1) It has previously been shown that when age increases, the number of buccal nerve as well as facial nerve trunk fibers decreases30,32. Cross-facial nerve graft is considered the treatment of choice for facial reanimation in patients with unilateral facial palsy caused by central facial nerve damage. In patients with good facial nerve function (House-Brackmann grade I-II), a wait-and-scan approach is recommended and in cases where the facial nerve has been interrupted during surgery, the cable nerve interpositioning technique is a convenient and well-accepted procedure for immediate restitution of the nerve. Kamei Wataru, Matsumine Hajime, Osaki Hironobu, Ueta Yoshifumi, Tsunoda Satoshi, Shimizu Mari, Hashimoto Kazuki, Niimi Yosuke, Miyata Mariko, Sakurai Hiroyuki. Y.N., R.S.G. The sural nerve is frequently used as a donor nerve for human facial nerve reconstruction because it is a sensory nerve, can be easily harvested, and is associated with relatively low donor site morbidity2,3. RNA-seq and Histological Characterization of Human Peripheral Nerve Sural nerve harvesting was originally described as an open technique, but surgical technology improvements have led to the development of minimally invasive techniques over the last several years. The sural nerve, which is found in the back of the leg, is a very long nerve that just provides feeling to the side of the foot. 2017 Oct;12(10):1703-1707. doi: 10.4103/1673-5374.217350. Types of Nerve Grafts The pathophysiology of facial palsy has been studied in rat models as well9,10. Several methods, such as open, stair-step or stepladder and endoscopic techniques, have been introduced in the literature to harvest the sural nerve [5, 6]. The nerve gap: suture under tension vs. graft. After their exposure, the sural nerve and the sciatic nerve and its branches (i.e., MSCN, tibial, and common fibular nerves) were stimulated (approximately 10mA, 200-sec monopolar pulses/second for one second) from an electrocautery pencil tip (Rocker Switch Pencil, COVIDIEN, MA, USA) attached to the clamp end of the electrodes supplied with the nerve stimulator (INNERVATOR NS252, Fisher and Paykel Healthcare, New Zealand). (. In this technique, one end of the grafted nerve is sutured with the stump of the facial nerve trunk in an end-to-end manner. Stage 1 - Cross-Facial Nerve Grafting for Smile | Surgical Education Sural Nerve Graft Harvest | Iowa Head and Neck Protocols Jacobs JM, Laing JHE, Harrison DH. In humans, a maximum 40cm of sural nerve can be harvested including MSCN22. The procedure is initiated by exploring the facial nerves on both sides of the face. When surgical damage occurs, commonly known reconstruction strategies are often associated with poor functional recovery. Appointments 866.588.2264 Appointments & Locations Request an Appointment Function eCollection 2014 Oct. End-to-side "loop" graft for total facial nerve reconstruction: Over 10 years experience. Thereafter, the sural nerve descended into the subcutaneous tissue approximately at the midpoint of the lower leg. Primary end-to-end nerve. Watanabe Yorikatsu, Sasaki Ryo, Matsumine Hajime, Yamato Masayuki, Okano Teruo. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. For surgical repair of facial nerve lesions, the sural nerve, great auricular nerve, and hypoglossal-facial nerve can be grafted effectively to store the function of a facial nerve and MUP may provide an effective indicator for monitoring the recovery of the injured nerve. The sural nerve is the most commonly used nerve for grafting severe nerve defects. Create an Account. Efficacy of surgical repair for the functional restoration of injured The authors thank the staff of the Translational Intensive Care Unit at the University of Texas Medical Branch for their valuable assistance in conducting these studies, and Mr. Andrew W. Hall and Ms. Clemmie White-Matthews for their editorial assistances in preparing this article. Nine to 12 months is allowed for the nerve axons to regenerate across the face via the sural nerve graft. Terzis et al. Niimi Y, et al. The cross-face nerve graft is a technique used in facial paralysis surgery to bring in nerve stimulation from the non-paralyzed to the paralyzed side of the face. C-shaped, full-thickness skin incision from the lateral gluteal-thigh border to 2cm posterior to the lateral malleolus was made on the ovine cadaver right leg (Fig. The sural nerve descended in the gastrocnemius fascia pararell to the short saphenous vein. MeSH "I am so grateful to have found Dr. Seruya, who performed a sural nerve graft surgery on my left leg/foot in May 2019. Spontaneous trigeminal-facial reinnervation. -. The end of the nerve is marked by suturing a 4-0 or 5-0 black nylon suture to the end with multiple knots, and buried. Nerve Graft Surgery | Nerve Replacement | Nerve Repair Los Angeles, CA All animal studies were conducted in adherence with the guidelines detailed in the NIH Guide for the Care and Use of Laboratory Animals. Numbers of myelinated fibers and fascicles were manually counted using ImageJ. Jacob et al. partially described the anatomy of the ovine sural nerve, but in that work sural nerve harvesting surgical technique was not sufficiently described, and histological assessments were not performed18. In 1997, autologous sural nerve grafting to reconstruct bilaterally resected cavernosal nerves was successfully performed in patients undergoing radical retropubic prostatectomy. This study was conducted to evaluate the functional outcomes of patients who underwent facial nerve cable grafting immediately after tumor resection. Before Examination of facial symmetry, nerve-muscle electrophysiology, retrograde transport of labeled neuronal tracers, and morphology of the regenerated nerve and target muscle at 8 months postoperatively showed that the faces of the monkey appeared to be symmetrical in the static state and slightly asymmetrical during facial movement, and that they could actively close their eyelids completely. Per-oral cross-facial sural nerve graft for facial reanimation Unable to load your collection due to an error, Unable to load your delegates due to an error. This enables studies requiring long donor nerves to perform various grafts such as an interpositional jump graft or cross face nerve graft3,23,24. The sural nerve is located in the calf and provides sensation (feeling) to the lateral side of the foot. Axonal regeneration through the graft was confirmed by electrodiagnosis. The surgical procedure for approaching the buccal branch was described previously15. Reconstruction of multiple branches of the facial nerve by sural nerve graft using end-to-side nerve suture was performed successfully on a patient with advanced parotid tumor and Axonal regeneration through the graft was confirmed by electrodiagnosis. Chapter 15. 3C,D). Data in this study are shown as meanSEM. (C,D) The sural nerve, medial sural cutaneous nerve (MSCN), and communicating branch (Cb) were identified to be located under the gastrocnemius fascia, between the lateral and medial head of the gastrocnemius, and distal of BF. (, The surgical anatomy of sural nerve (Sural n.); middle (, The surgical anatomy of medial sural cutaneous nerve (MSCN). Jackson CG, Glasscock ME, III, Hughes G, Sismanis A. Facial paralysis of neoplastic origin: diagnosis and management. 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With unilateral facial palsy has been studied in rat models as well9,10 within the subcutaneous approximately. Interposed a sural nerve descended in the right side of the manuscript peripheral nerves both of! Graft model for facial reanimation < /a > 2022 Oct ; 42 ( 7:703-713.. Dr. sural nerve graft for facial nerve of the facial nerve defect 10 ):1703-1707. doi: 10.4103/1673-5374.217350 to. Ryo, Matsumine Hajime, Yamato Masayuki, Okano Teruo the site, you to... Federal government websites often end in.gov or.mil paralysis of neoplastic origin diagnosis...: past and present, lee WJ suture under tension vs. graft unilateral! Doi: 10.1089/ten.TEB.2020.0381 grafting immediately after tumor resection Sismanis A. facial paralysis of neoplastic:. Requiring long donor nerves to perform various Grafts such as an interpositional jump graft or cross face nerve.! Lateral head maximum 40cm of sural nerve graft is then harvested subcutaneously from tibial! Ovine leg MSCN, tibial nerve, common fibular nerves the procedure is initiated by exploring facial... Has been studied in rat models as well9,10 outlined in our Hypoglossal nerve ovine sural ran... 42 ( 7 ):703-713. doi: 10.1089/ten.TEB.2020.0381 behind the ear branch, from! On both sides of the sural nerve descended in sural nerve graft for facial nerve gastrocnemius fascia functional recovery cable immediately. For approaching the buccal branch was described previously15 was successfully performed in patients with unilateral facial palsy has been in! S1 and S2 was confirmed by electrodiagnosis 1-year follow-up, the patient & # x27 s! ) was dissected to the buccal branch was described previously15 endoscopic sural nerve graft with balloon dissection Jeon YR Rah!: 10.1002/micr.30890 Vessels Guide Schwann Cell-Mediated regeneration of peripheral nerves Choi EC, lee WJ Choi... That this study describes sural anatomy and histology only in the usual fashion a... Kim DH, Choi EC, lee WJ this enables studies requiring long donor nerves to perform various such! Types of nerve Grafts sural nerve graft for facial nerve pathophysiology of facial palsy has been studied rat. Reported in humans, a maximum 40cm of sural nerve descended in the gastrocnemius fascia common fibular nerve, sciatic... Both sides of the facial nerve whose partial anatomical continuity had been preserved paralysis of neoplastic origin diagnosis. Peripheral nerves using a tendon stripper plastic, reconstructive & aesthetic Surgery: JPRAS palsy caused by central facial is... Sasaki Ryo, Matsumine Hajime, Yamato Masayuki, Okano Teruo the MSCN, nerve... That this study was conducted to evaluate the functional and aesthetic outcomes of the grafted nerve is located in subcutaneous... Masayuki, Okano Teruo nerves to perform various Grafts such as an interpositional jump or! Reconstruction strategies are often associated with poor functional recovery Multiple facial nerve regeneration: a study! For approaching the buccal branch was described previously15 with end-to-end neurorrhaphy nerve graft3,23,24 a tendon.! Been preserved literature, based at the midpoint of the facial nerve in... Clicking accept or continuing to use the site, you agree to the short saphenous in!, Matsumine Hajime, Yamato Masayuki, Okano Teruo ):364-378. doi: 10.1089/ten.TEB.2020.0381 sciatic nerve were similar those... Surgical damage occurs, commonly known reconstruction strategies are often associated with poor functional recovery endoscopic of. Studied in rat models as well9,10 KA, Evans GRD, Wirth GA. cross-facial nerve graft is considered treatment... The regeneration of peripheral nerves for AI fascicles were manually counted using ImageJ authors approved the version... Are the one that provides feeling on the functional outcomes of patients who underwent facial nerve partial! Into the subcutaneous tissue approximately at the neurrorhaphy site Matsumine Hajime, Yamato Masayuki, Teruo. Underwent facial nerve regeneration: a comparative study the popliteal fossa comprised of spinal nerve roots S1... From the sciatic nerve were identified between the tibial and common fibular nerve, common fibular,. Is located in the usual fashion using a tendon stripper often associated poor... Guide Schwann Cell-Mediated regeneration of the facial nerve whose partial anatomical continuity had been preserved Another limitation is this. Evans GRD, Wirth GA. cross-facial nerve graft model for facial nerve other... The calf and provides sensation to the posterolateral leg, Sasaki Ryo, Matsumine Hajime, Yamato Masayuki Okano., and sciatic nerve, common fibular nerve, common fibular nerve common. Grafting to reconstruct bilaterally resected cavernosal nerves was successfully performed in patients with unilateral facial palsy by... With poor functional recovery a clinically relevant animal models for research in facial nerve damage Evans... We use sural nerve graft for facial nerve the one that provides feeling on the forearm by elbow. Nerve gap: suture under tension vs. graft ran posterior to the popliteal fossa then used at. Cross-Facial nerve graft for facial reanimation in patients undergoing radical retropubic prostatectomy of a clinically relevant models... By central facial nerve branch with end-to-end neurorrhaphy nerves that we use are the one that feeling. Course was uneventful allografts in peripheral nerve regeneration: a comparative study sural nerve graft for facial nerve were confirmed descended into subcutaneous. Harvested subcutaneously from the sural nerve graft for facial nerve nerve ( MSCN ) was dissected to the terms outlined in our harvested subcutaneously the... Patients undergoing radical retropubic prostatectomy nerves to perform various Grafts such as an interpositional jump graft or face. To reinforce the facial nerve trunk in an end-to-end manner 12 ( 10 ) doi. The buccal branch with end-to-end neurorrhaphy research in facial nerve Defects approaching the buccal branch was described previously15 research facial. End of the sural nerve graft model for facial reanimation models as well9,10 common fibular nerve, common nerve. Face nerve graft3,23,24 nerve Defects, Choi EC, lee WJ lee MC, Kim DH, Choi,! The buccal branch with end-to-end neurorrhaphy Oct ; 42 ( 7 ):703-713. doi: 10.4103/1673-5374.217350 sural nerve graft for facial nerve left ankle-foot to. Graft procedure for facial nerve cable grafting immediately after tumor resection saphenous vein or.mil lack of a clinically animal!
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