Minimizing donor site morbidity using the interfascicular nerve
splitting technique in single-stage latissimus neuromuscular transfer
for facial reanimation: a retrospective study
Abstract
Introduction Free muscle transfer for facial reanimation requires the
sacrifice of motor nerves and muscles, which inevitably leads to donor
site morbidity. To overcome this, the authors performed the
interfascicular nerve splitting technique during neurovascular
latissimus dorsi flap harvest. The aim of this study was to examine the
efficacy of our interfascicular nerve splitting technique through the
evaluation of donor site morbidity. Methods Records of patients in who
the free latissimus dorsi flap was employed with the interfascicular
nerve splitting technique between 2012 and 2016 were reviewed.
Postoperative donor site morbidity was evaluated using electromyography,
nerve conduction studies, and the Quick-Disabilities of Arm, Shoulder,
and Hand questionnaire (QuickDASH). Results A total of 13 patients were
analyzed. Grades from the electromyography and nerve conduction study
were not significantly different between the donor site and
contralateral side (0.42±0.51 and 0.08±0.28, respectively, P = .073).
QuickDASH scores showed different results over time. Preoperative
QuickDASH scores averaged 1.57±2.34. At postoperative 6 months, the
average QuickDASH score was 8.74±4.62, which was significantly different
from the preoperative average (P = .001). At postoperative 12 months,
QuickDASH scores averaged 2.62±3.19, which was an improvement from the
postoperative 6-month score. However, the improvement was not
significantly different from the preoperative score (P = .059).
Conclusion The present study showed that interfascicular nerve splitting
could minimize donor site morbidity. Moreover, our results suggest that
the split nerve can function as a donor nerve. Our novel method could be
a valuable option for minimizing donor site morbidity during facial
reanimation surgery.