Abstract
The authors present a clinical scenario of a 57 years-old man with a soft tissue sarcoma that underwent tumor resection including soft tissue, part of the mandible, and the marginal mandibular nerve branch, with a resulting nerve gap of 7 cm. Nerve reconstruction was performed with a vascularized vastus lateralis motor nerve graft along with a free anterolateral thigh flap. Two years postoperatively, the patient is tumor-free and shows good symmetry and function in the lower lip depressors and mentalis.
Vascularized nerve grafts are best suited for reconstruction of large nerve defects and when the local conditions are suboptimal (e.g., radiation, scarred bed), since they provide more effective and faster nerve regeneration. The free anterolateral thigh flap and the vastus lateralis motor nerve are a good option for the complex facial nerve and soft tissue defects.
Critical steps in this procedure include the use of intraoperative templates to shape the ALT, selection of a proper vascularized nerve graft donor site, pedicle and vascularized nerve graft dissection, and final insetting of nerve, vascular pedicle, and soft tissue.
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Vieira, L., Rodriguez-Lorenzo, A. (2020). Vascularized Vastus Lateralis Nerve Graft for Reconstruction of Composite Facial Nerve Defect. In: Clinical Scenarios in Reconstructive Microsurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-94191-2_119-1
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DOI: https://doi.org/10.1007/978-3-319-94191-2_119-1
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