title: Vastus lateralis vascularized nerve graft in facial nerve reconstruction: an anatomical cadaveric study and clinical implications.
abstract: BACKGROUND
  The present study investigates the vascular anatomy of the vastus lateralis motor nerve (VLMN) to be used as a vascularized nerve graft in facial nerve reconstruction. We evaluated the maximum length of the nerve that can be included in the flap and its vascular pedicle. In addition, we discuss its adequacy for use in early reconstruction of the facial nerve both as ipsilateral facial nerve reconstruction and as cross-facial nerve graft.
  
  
  METHODS
  Five fresh cadavers were used in this study. In all specimens, the VLMN and its vascular pedicle were dissected, photodocumented and measured using calipers. In addition, two vascularized VLMN were injected with a radiopaque contrast and underwent CT angiography and three dimensional reconstructions were scanned to illustrate the vascular supply of the nerve using OsiriX Software.
  
  
  RESULTS
  The VLMN was divided into two divisions, an oblique proximal and a descending distal, in 70% of the dissections with a mean maximal length of 8.4 ± 4.5 cm for the oblique division and 15.03 ± 3.87 cm for the descending division. The length of the oblique division, when present, was shorter than the length of the descending branch in all specimens. The mean length of the pedicle was 2.93 ± 1.69 cm, and 3.27 ± 1.49 cm until crossing the oblique and the descending division of the nerve respectively. The mean caliber of the nerve was 2.4 ± 0.62 mm. Three-dimensional computed tomography angiography demonstrated perfusion throughout the entire VLMN by branches from the descending branch of the lateral femoral circumflex artery which ran parallel to the descending division of the VLMN. Additionally, we observed that technically it was possible to preserve the oblique branch of the VLMN.
  
  
  CONCLUSIONS
  This study confirms that VLMN presents adequate anatomic features to be used as a vascularized nerve graft for facial nerve reconstruction in terms of length, pedicle, and caliber.
authors.affiliation: Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Agrogiannis
authors.forename: Shai
authors.initials: S
authors.lastname: Rozen
authors.forename: Gangadasu
authors.initials: G
authors.lastname: Reddy
authors.forename: Thorir
authors.initials: T
authors.lastname: Audolfsson
authors.forename: Andres
authors.initials: A
authors.lastname: Rodriguez-Lorenzo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005154:Facial Nerve / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010525:Peripheral Nerves / Q000098:blood supply* / Q000637:transplantation; D052097:Quadriceps Muscle / Q000098:blood supply / Q000294:innervation*; D019651:Plastic Surgery Procedures / Q000379:methods*