University Journal of Surgery and Surgical Specialities
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A Early Functional Recovery Of Upper Aerodigestive Tract Reconstruction Using Neurotized Free Flaps Of Various Postexcisional Defects- A Retrospective Clinical Study
Abstract
Introduction: A Retrospective study of neurotized free flaps
used for the reconstruction of various upper aerodigestive
tract defects. Usually, the Sources ofnerve selected as a inert
graft, the most frequently used nerves are the sural nerve,
and the medial and lateral antebrachial cutaneous nerves
without vascularity. If the vascularity to cytoskeleton of the
nerve could be preserved which is possible with nerves
traversing the free flaps has the advantage of faster axonal
regeneration andless axonal wastage. This brings a early
functional recovery of reconstructed site of upper
aerodigestive tract.
Aim & objectives: To provide early proprioception/protective
sensational recovery tothe cutaneous paddle for the early
functional recovery in the neurotized area by using a
neurotized free flaps for various upper aerodigestive tract
defects.
Materials and Methods: In this retrospective clinical study,
the duration being done between September 2014 to May
2017, totally 40 patients are selected, males-27 and females
-13. From this clinical study , the reconstruction of upper
aerodigestive tract of various post excisional defects are
resurfaced by using neu rotized free flaps ,here about 28
patients free radial forearm flap with medial/lateral cutaneous
N of forearm was harvested based on radial artery, 12 cases
chimeric free fibula flap harvested along with superficial
peroneal nerve based on peroneal artery used to
reconstruct various post excisional defects of upper
aerodigestive tract, here the various recipient nerves used
for coaptation with the donor nerve harvested along with
free flaps for neurotisations of the target sites are greater
auricular N, sensorybuccal branch of trigeminal N, lingual
N and inferior dental N for early functional outcomes to
the recipient site.
Results: In our study, the functional recovery were
assessed by two independentobservers using two point
discrimination recovery scale for recovered functions like
speech, swallowing and competency of upper
aerodigestive tract from a sensory feedback which
necessitate close coordination between sensory and motor
functions. On an average of 8.5 months duration all
patients had 10mm of two point discrimination in the
reconstructed area with lead time of 2.5 months by using
neurotized free flaps when compaired with non neurotized
free flaps, which helped them bringing back the
proprioception and sensory feedback for useful upper
aerodigestive tract functions.
Conclusion : With significant p value <0.5 using a
retrospective clinical study, it has been established that
neurotized free flaps has a definitive lead time bringing the
faster recovery of function like proprioceptions/protective
sensation to the recipient site.
Full Text:
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