Neuronal structure of microvascular transplants with and without neuronal anastomosis.
OBJECTIVE
Latissimus dorsi transplants have little neuronal regenerative capacity without neuronal anastomosis. Histologic differences between transplants with and without neuronal anastomosis and 2 distinct types of neurosurgical reanastomosis are highlighted in this study.


METHODS
Fifty-four patients with squamous cell carcinomas of the oral cavity (T4) were treated by tumor resection and homolateral neck dissection. The defect was covered with a microvascular latissimus dorsi transplant. In 15 patients, no neuronal anastomoses were performed. In 21 patients, the thoracodorsal nerves were used for microneurosurgical reanastomosis, whereas in 18 patients, the cutaneous branches of the intercostal nerves were used for microneurosurgical reanastomosis. The transplant was examined during surgery and 9 months after surgery by means of a histologic examination of a biopsy specimen. The number of fascicles, the degree of fibrosis, and the myelination were examined. Furthermore, a neurosensory examination was performed 9 months after surgery.


RESULTS
Overall, our patients had an average of 12.1 fascicles during surgery. After surgery, patients without neuronal anastomosis showed an average of 4.9 fascicles, patients with nerve anastomosis to the cutaneous branches of the intercostal nerve showed an average of 6.2 fascicles, and patients with anastomosis to the thoracodorsal nerve showed an average of 9.6 fascicles. In cases of nerve anastomosis, a lesser degree of fibrosis was found, together with good myelinization. The clinical examination showed the best neurosensory function in the transplants with anastomosis to the thoracodorsal nerve and the worst function in those without neuronal anastomosis.


CONCLUSIONS
Neuronal reanastomosis led to more surviving neuronal structures in the postoperative histologic specimen. The highest density of fascicles was found in the well vascularized thoracodorsal nerve. The neurosensory function agrees with the histologic result.
Gaggl
A
A
Department of Oral and Maxillofacial Surgery, University Clinics, Graz, Austria.
Schultes
G
G
Kärcher
H
H
Kleinert
R
R
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D016025:Bone Transplantation / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000534:rehabilitation; D004431:Ear, External / Q000293:injuries; D006801:Humans; D007367:Intercostal Nerves / Q000098:blood supply / Q000637:transplantation; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000534:rehabilitation; D008833:Microcirculation; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000294:innervation* / Q000637:transplantation*; D009412:Nerve Fibers; D009416:Nerve Regeneration; D009460:Neurologic Examination; D019635:Neurosurgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures; D012540:Scapula / Q000294:innervation / Q000637:transplantation; D012677:Sensation; D013900:Thoracic Nerves / Q000098:blood supply / Q000637:transplantation*; D016896:Treatment Outcome