Facial nerve reconstruction using vascularized nerve grafts based on the lateral femoral circumflex vascular system

When unilateral facial nerve resection is performed for tumor resection, immediate reconstruction is desirable to achieve more natural recovery of facial expressions. We performed facial nerve reconstruction using vascularized nerve grafts based on the lateral femoral circumflex vascular system. Herein, we describe the details, advantages, and challenges associated with this technique.

We evaluated 9 patients who underwent reconstruction using a vascularized nerve graft harvested from the lateral femoral circumflex vascular system. All patients had at least 1 year of postoperative follow-up. Data collected included the primary disease, extent of resection and reconstruction, presence of vascular complications of the flap, postoperative contour deformity, facial muscle function beyond 1 year, and other complications. Facial function was evaluated using the Sunnybrook Facial Grading Score.

All patients underwent total parotidectomy with unilateral facial nerve resection, followed by reconstruction using vascularized nerve grafts based on the lateral femoral circumflex vascular system. All flaps survived without vascular complications, and no postoperative facial contour depression occurred. The mean postoperative Sunnybrook Facial Grading Score was 39.1 (range, 23-65). One patient developed Frey's syndrome. No donor-site complications or functional losses were observed. The reconstruction time was less than 3 h in all cases.

This technique enables efficient reconstruction using vascularized motor nerve grafts. Early neural regeneration can occur before facial muscle atrophy develops, making it particularly suitable for middle-aged and older patients, as well as for those with irradiated surgical fields, in whom conventional nerve grafts often yield limited functional recovery.