PDF herunterladen
CC BY-NC 4.0 · Arch Plast Surg 2012; 39(01): 71-75
DOI: 10.5999/aps.2012.39.1.71
Idea and Innovation

Vein Wrapping Technique for Nerve Reconstruction in Patients with Thyroid Cancer Invading the Recurrent Laryngeal Nerve

Young Moon Yoo
Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
,
Il Jae Lee
Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
,
Hyoseob Lim
Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
,
Joo Hyoung Kim
Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
,
Myong Chul Park
Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Recurrent laryngeal nerve paralysis is the most common and serious complication after thyroid cancer surgery. The objective of this study was to report the advantages of the vein wrapping technique for nerve reconstruction in patients with thyroid cancer invading the recurrent laryngeal nerve and its effects on postoperative phonatory function. The subjects were three patients who underwent resection of the recurrent laryngeal nerve during surgical extirpation of papillary thyroid cancer. Free ansa cervicalis nerve graft or direct neurorrhaphy with a vein wrapping technique was used to facilitate nerve regeneration, protect the anastomosed nerve site mechanically, and prevent neuroma formation. One-year postoperative laryngoscopic examination revealed good vocal cord mobility. Maximum phonation time (19.5 ± 0.3 sec) was longer than a previously-reported value in conventional reconstruction patients (18.8 ± 6.6 sec). The present phonation efficiency index (7.88 ± 0.78) was higher than that previously calculated in conventional reconstruction (7.59 ± 2.82). The mean value of the Voice Handicap Index-10 was 6, which was within the normal range. This study demonstrates improvement in phonation indices measured 1 year after recurrent laryngeal nerve reconstruction. Our results confirm that the vein wrapping technique has theoretical advantages and could be favored over conventional reconstruction techniques for invenerate nerve injuries.

Keywords

Recurrent laryngeal nerve - Thyroid neoplasms - Nerve regeneration - Phonation - Vocal cords

This article was presented as a poster in the 68th Congress of the Korean Society of Plastic and Reconstructive Surgeons, on November 4-7, 2010 in Seoul, Korea and 6th Congress of the World Society for Reconstructive Microsurgery, on June 29-July 2, 2011 in Helsinky, Finland.




Publikationsverlauf

Eingereicht: 06. Oktober 2011

Angenommen: 19. Dezember 2011

Artikel online veröffentlicht:
01. Mai 2022

© 2012. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Chiang FY, Lu IC, Kuo WR. et al. The mechanism of recurrent laryngeal nerve injury during thyroid surgery: the application of intraoperative neuromonitoring. Surgery 2008; 143: 743-749
    CrossrefPubMedGoogle Scholar
  • 2 Snyder SK, Lairmore TC, Hendricks JC. et al. Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. J Am Coll Surg 2008; 206: 123-130
    CrossrefPubMedGoogle Scholar
  • 3 Yumoto E, Sanuki T, Kumai Y. Immediate recurrent laryngeal nerve reconstruction and vocal outcome. Laryngoscope 2006; 116: 1657-1661
    CrossrefPubMedGoogle Scholar
  • 4 Miyauchi A, Matsusaka K, Kihara M. et al. The role of ansato-recurrent-laryngeal nerve anastomosis in operations for thyroid cancer. Eur J Surg 1998; 164: 927-933
    PubMedGoogle Scholar
  • 5 Lubiatowski P, Unsal FM, Nair D. et al. The epineural sleeve technique for nerve graft reconstruction enhances nerve recovery. Microsurgery 2008; 28: 160-167
    CrossrefPubMedGoogle Scholar
  • 6 Battiston B, Geuna S, Ferrero M. et al. Nerve repair by means of tubulization: literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair. Microsurgery 2005; 25: 258-267
    CrossrefPubMedGoogle Scholar
  • 7 Heijke GC, Klopper PJ, Baljet B. et al. Silicone rubber tubulization in peripheral sensory nerve reconstruction: an experimental study in rabbits. Microsurgery 2001; 21: 306-316
    CrossrefPubMedGoogle Scholar
  • 8 Meyer RS, Abrams RA, Botte MJ. et al. Functional recovery following neurorrhaphy of the rat sciatic nerve by epineurial repair compared with tubulization. J Orthop Res 1997; 15: 664-669
    CrossrefPubMedGoogle Scholar
  • 9 Miyauchi A, Inoue H, Tomoda C. et al. Improvement in phonation after reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve. Surgery 2009; 146: 1056-1062
    CrossrefPubMedGoogle Scholar
  • 10 Rosen CA, Lee AS, Osborne J. et al. Development and validation of the voice handicap index-10. Laryngoscope 2004; 114: 1549-1556
    CrossrefPubMedGoogle Scholar
  • 11 Arffa RE, Krishna P, Gartner-Schmidt J. et al. Normative values for the voice handicap index-10. J Voice 2011 Aug 3 [Epub]. DOI: 10.1016/j.jvoice.2011.04.006.
    CrossrefPubMedGoogle Scholar
  • 12 O'Neill JP, Fenton JE. The recurrent laryngeal nerve in thyroid surgery. Surgeon 2008; 6: 373-377
    CrossrefPubMedGoogle Scholar
  • 13 Galeano M, Manasseri B, Risitano G. et al. A free vein graft cap influences neuroma formation after nerve transection. Microsurgery 2009; 29: 568-572
    CrossrefPubMedGoogle Scholar