AESTHETIC HARVESTING OF THE SURAL NERVE IN FACIAL PALSY REANIMATION

By: LUIS EDUARDO BERMUDEZ R. MD.

Paper presented as scientific exhibit at the 1998 Global Summit on Aesthetic Surgery of the American Society for Aesthetic Plastic Surgery. Los Angeles. California. May 1-6 1998.

GOALS:

The cross facial nerve grafts (CFNG) are current procedures in the microsurgical reanimation of the paralyzed face. However the harvesting of the sural nerve usually leaves conspicuous scars which are unacceptable for patients looking for a better appearance. Is important develop an easy technique to harvest a healthy sural nerve with minimal scarring.

TECHNIQUE:

We use the Toledo’s V shape tip cannula (initially described for liposuction and treatment of the "cellulite") to create a subcutaneous pocket along the course of the sural nerve, dissect and harvest the sural nerve under direct visualization though a 4 mm, 30° endoscope. The space under the skin is maintained pulling the skin with several silk stitches.

RESULTS:

This procedure has been used in 4 patients, to harvest an average of 27 cms of sural nerve in patients undergoing cross facial nerve grafts:

Table No.1.

Scars in endoscopic harvesting of the sural nerve.

Patient. Graft length. Scars number.Scar length (mm) .

1.         26 cm             3                     10, 6, 4.

2.         24 cm             2                     10, 6.

3.         30 cm             3                     10, 10, 6.

4.         28 cm             3                     10, 8, 6.

The technique is easy and does not need the development of new instrumentation. In this way we harvest the sural nerve leaving 2 or 3 inconspicuous scars of 4 to 10 mm length.

PHOTOGRAPHS

In the next pictures you can see how the cannula is used to dissect the sural nerve.

Picture 1: Fibrous septum (FS) between the sural nerve (SN) and surrounding tissues.Picture 2: Cannula in position before break the septum.Picture 3: Cannula bluntly breaking the septum.Picture 4: Taking out the cannula after release the sural nerve from the surrounding tissues.

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  Picture 5: Toledo’s cannula tip. Picture 6: Outer view of the harvesting of the sural nerve. C: Hand holding the cannula. E: Hand holding the endoscope. S: Hand pulling silk stitches to create a space. Picture 7: Sural nerve harvested through 2 small incisions (arrows). Picture 8: Picture of the healed scars in another patient.

CONCLUSION:

With the endoscopic harvesting of the sural nerve using the Toledo cannula we have developed an easy technique to harvest the sural nerve with a better aesthetic outcome in the patients who undergo cross facial nerve grafts as part of the treatment of their facial palsy.