Axonal Regeneration In Autologous Grafts: Does A Single-Stage Muscle Transfer Improve Functional Outcomes?
Scott R. Echternacht, BA1, Miranda A. Chacon, BS2, Michael F. Catanzaro, MD3, Adriaan O. Grobbelaar, MB, ChB, MMed, FCS4, Jonathan I. Leckenby, MD, PhD, MRCS3.
1University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, 2Geisinger Commonwealth School of Medicine, Scranton, PA, USA, 3Division of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, NY, USA, 4Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, United Kingdom.
The current optimal surgery for unilateral facial paralysis is a two-stage procedure consisting of a cross facial nerve graft (CFNG) and a free vascularised muscle transfer with attachment of the transposed muscle’s nerve to the CFNG. However, only 60% of patients obtain an excellent result. This study sought to investigate the cause for poor axonal regeneration.
A three-phase prospective study was conducted. First, 15 patients underwent a two-stage CFNG. Second, 80 mice received nerve transection with either direct repair (DNR) or with an interposed peroneal nerve graft (NGr). Third, 10 patients underwent a single-stage procedure utilizing a vascularised latissimus dorsi muscle with coaptation of its nerve to a buccal ‘donor’ nerve.
The functional eFACE score of the 15 patients improved from 44 to 78 (p<0.05) at two-years follow-up. Only 48% of axons regenerated across the first neurorrhaphy. At post-operative week 48, the DNR group had better recovery of ear movement than the NGr group (76% vs 30%; p<0.05). There was no difference in axonal counts of the donor nerve between the groups. The DNR group had more axons regenerate across a neurorrhaphy and available for regeneration (79%; p<0.05). The eFACE score of the 10 patients improved from 41 to 89 (p<0.05) at two-years follow-up; these scores were better than the two-stage patient group (p<0.05). There was no difference in axonal counts of the donor nerve between the groups.
CFNG is detrimental to axonal regeneration and a single-stage procedure is preferred for optimal outcome in facial palsy.
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