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Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Autologous nerve transplantation is nearly always possible, if not nerve conduits (NCs) may be considered. They seem to be better for small sensory nerves. Options include the following: Silicone and PTFE tubes. Early use based on biocompatibility and availability; most current NCs are made of biodegradable materials, e.g. polyglycolic acid (Neurotube™), and can be quite pricey.Vein conduit acceptable for defects up to 3 cm; tendency to collapse and may actually hinder growth.Bone, denatured skeletal muscle.Nerve allograft (MacKinnon SE, Plast Reconstr Surg, 2000); as allograft only needed temporarily, immunosuppression can be stopped after ~6 months.Fibronectin impregnated with growth factors, pseudosynovial sheaths.Human nerve growth factor (NGF) and glial growth factor (GGF) may augment regeneration. Nerve conduits guide the regenerating nerves, but improved recovery may come from also providing GF delivery (Madduri S, J Control Release, 2012).
Trends and characteristics of neurotization during breast reconstruction: perioperative outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Elizabeth Laikhter, Eric Shiah, Samuel M. Manstein, Carly D. Comer, Valeria P. Bustos, Samuel J. Lin
In this cohort of patients, neurotization was more commonly performed during autologous reconstruction. Autologous reconstruction affords further dissection of donor nerves, minimizing tension introduced during connection to recipient nerves [13]. The first published study reporting breast neurotization described TRAM flap re-innervation by connecting the rectus intercostal nerve end-to-end to the lateral mammary ramus of the fourth intercostal nerve [19]. Autologous reconstruction with end-to-end or end-to-side direct nerve coaptation were the main methods described in literature until the first study utilizing a synthetic nerve conduit was published in 2013 [13]. More recent studies have reported neurotization for implant-based reconstruction with use of a nerve allograft [8,14]. In our cohort of patients, neurotization was more frequently performed using synthetic nerve conduits and allografts than by direct coaptation. Almost all patients with neurotization during implant or TE placement had re-innervation with synthetic nerve conduit or vein allograft. This patient cohort with breast neurotization captured by the ACS-NSQIP database appears to reflect that plastic and reconstructive surgeons are implementing novel breast re-innervation techniques and technologies.
Corneal Neurotization: Review of a New Surgical Approach and Its Developments
Published in Seminars in Ophthalmology, 2019
Natalie Wolkow, Larissa A. Habib, Michael K. Yoon, Suzanne K. Freitag
For many oculoplastic surgeons, the direct supraorbital or supratrochlear nerve transfer with or without the assistance of an endoscope16 or the indirect approach with an acellular nerve allograft connecting to the supraorbital, supratrochlear or infraorbital nerve23 would be the most attractive and technically easiest to adopt. Many oculoplastic surgeons perform endoscopic brow lifts as part of their practice, are familiar with the anatomy and have the required surgical equipment. Oculoplastic surgeons also routinely access the superior orbital rim via eyelid crease incisions and gain transconjunctival access to the orbital floor where the infraorbital nerve resides. The acellular nerve allograft approach is attractive as it does not require additional special equipment, is minimally invasive and is a more efficient than harvesting an autologous nerve graft. The cost for an acellular nerve graft is reasonable, currently in the $3000–5000 range, particularly when considering the potential donor site morbidity and surgical time saved for the patient and the hospital. Approaches that require sural nerve grafts or greater auricular nerve grafts in most cases will require the assistance of a second surgical team, as most oculoplastic surgeons do not routinely harvest sural or greater auricular nerve grafts.
Fascicular turnover flap in the reconstruction of facial nerve defects: an experimental study in rats
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Miyuki Uehara, Wu Wei Min, Moriaki Satoh, Fumiaki Shimizu
In cases of facial nerve gap repair, autologous nerve grafts are recognized as the only clinically effective choice [1–3]. Recently, Mackinnon et al. reported the utility of acellular nerve allograft, and this procedure is now widely used [13]. There have also been a number of studies regarding artificial nerve development, and various products are currently widely used in different countries [4–7,14]. Many biodegradable polymers, including polylactic acid (PLA), polyglycolic acid (PGA) and polylactic-co-glycolic acid (PLGA), have been reported [4–7,14]. However, these kinds of acellular compounds seem to have limited indications for nerve gap reconstruction. Indeed, a long nerve gap (more than 3 cm) is difficult to reconstruct without cell components [13].