Tiam Mana Saffari

101 REVASCULARIZATION PATTERNS OF NERVE ALLOGRAFTS 5 surface areas are seen and these methods are correlated 19 , however, based on the findings of this study, vascular volume is preferred. The blood supply of the recipient bed affects the success of a nerve graft substantially, which is believed to be resulting in early revascularization of the graft and ultimately speed of axonal regeneration and degree of restored function of the target muscle 22 . Central necrosis of thick nerve grafts has been a confirmed problem and commonly described as necrosis of the central ring of the graft (core necrosis) 7,27-29 . Our data are consistent with previous studies in which not only the core but also the central section of the length of the allograft nerve has been shown to be predisposed to avascularity, with potentially higher risk of necrosis 30 . A VNG greatly affects vascularization, impeding both types of central necrosis. Due to a decrease in graft ischemic time, VNGs are suggested to lead to faster nerve regeneration than nonvascularized nerve grafts (NVNG) 30 . However, the rate of axonal regeneration has not found to be different between non-vascularized and conventional nerve grafts 30-32 . Functional recovery needs to be tested, as suggested to be positively affected by VNGs 11 . The theoretical advantages of a VNG or provision of a well-vascularized bed for the nerve graft are well accepted 7 . Maintaining vascularization after nerve injury may yield several advantages: not only may it restore extrinsic neural blood vessels that were damaged during nerve trauma, intraneural fibrosis secondary to ischemia will also be reduced. This may result in an increase of axonal regeneration particularly in thicker grafts 22,33 , subsequently preventing target muscle atrophy 7 . In order to have these potential advantages, surgically provided vascularization to the nerve site needs to be applied accurately. The vascular pedicle should be of large enough diameter to support microvascular anastomoses in the case of free flaps. To overcome this problem a simple pedicled flap could be used. Another condition that influences the outcomes of the peripheral nerve is the fact that blood supply should emanate from a vascular pedicle that travels parallel with the nerve over an adequate distance 22,33 . The surgical technique that provides the pedicled adipofascial flap has been validated while taken these prerequisite conditions in account 15 . The limitation of this study is the large time gap between the short-term and long- term outcomes. To better describe revascularization patterns, time points at four or eight weeks may have provided additional information. Vascular response to nerve