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Reconstruction using Vasculized Free Nerve Flap For Limbs
Haruki Mizuta, MD
Tokyo University, Tokyo, Japan
Introduction: We often experience traumatic main neural trunk injury of limbs. When the both stumps of neural trunk are separated to some extent, free nerve graft get better result than nerve anastomosis in tension. Survival of explant nerve graft depends on randomized blood circulation resumption, in other words, free composite graft. Therefore, severe scar of peripheral tissue and long free nerve graft cause poor circulation of blood. It causes central necrosis of the nerve and interfere axonal regeneration severely. So we devise visualized free nerve flap, firstly harvest nerve graft with feeding vessel, secondly anastomos artery and vein in host site for blood resumption of free nerve flap.
Method: We perform 62 visualized free nerve flap cases among past 15 years. The breakdown is as follow. Main paralysis nerve reconstruction contains Brachial plexus, upper arm nerve, digital nerve post tibial nerve, planter nerve and so on. Nerve with deep peroneal nerve is 26 cases, with saphenous nerve is 18 cases. Reconstruction with deep peroneal with extensor digitorum tendon is 5 cases reconstruction with lateral femoral cutaneous (LFCN) nerve is 2 cases reconstruction with femoral nerve branch is 2 cases Main pedicle nerve transfer contains intercostal nerve to musculocutaneous or median nerve, accessory nerve to musculocutaneous or median, deep peroneal nerve result.
Results: About motor nerve reconstruction case, motor function is not regained enough in nerve reconstruction case passed over 6 month since Paralysis occurred. However, early nerve reconstruction results in enough muscle contraction. On the other hand, sensory nerve function reconstruction is often regained enough in nerve reconstruction case passed over 6 month since Paralysis occurred. Especially in young case, sensory nerve function is recovered excellently. However in elder case, there is a limit.
Conclusion: Visualized free nerve flap regenerates 25 cm motor axon of intercostal nerve among three month. Regenerated motor nerve make it possible that paralysis muscle and explant muscle are contacted voluntary. And it works out in host site with scar. Visualized nerve flap make it possible not only good regeneration in host site with poor circulation but also prompt regenerated nerve expansion. Then completely new nerve reconstruction method will be published for each nerve paralysis that we cannot treat before.
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