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The requirements for successful transplantation are rapid revascularisation, oxygenation, and innervation. This should be followed by full functional neuromuscular reinnervation. The transplanted organ may need to be revascularised for the local blood supply to recover; however, revascularisation of the ipsilateral arm donor is not necessary and has only a minor effect on the overall outcome [40]. The vascularised organ must become reinnervated. In most cases, this is done by a voluminous nerve. A muscle can also be used as a donor nerve and can be attached to a nearby nerve by microsurgical anastomoses. Free functioning muscle transfer can be used for all kinds of nerve injuries. The internationally recognised and validated nerve and muscle classification system assesses the quality of the surviving donor nerve and the degree of recovery of the reinnervated muscle graft from normal to excellent with a negligible risk of muscle atrophy and loss of function. This technique is now well established for both motor and sensory functions [40,41].
Millions of dollars are spent each year on repairs and replacements of facial bone defects that are rarely critical enough to compromise function or jeopardize social functioning. However, reconstructive failures will usually entail the need for more than one surgical procedure. In most cases, the failure is not related to the technique itself but to inadequate patient selection, poor postoperative wound care, or inadequate postoperative pain management. The variety of reconstructive problems is due, in part, to a lack of consensus on what is an acceptable degree of aesthetic and functional outcome. d2c66b5586