Since 2000 we have used primary nerve grafts to reconstruct facial nerve defects caused by tumor ablation in a parotid region in 16 patients (12 males and 4 females aged from 31 to 79 years old, 64.3 on average) . The extent of sacrificed facial nerves was from 1 branch to total, and the maximum length of the nerve gaps was 11cm. For facial nerve reconstruction, a free nerve graft was used in 5 patients (from the great auricular nerve in 2 patients and the sural nerve in 3 patients) and a

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... arized sural nerve graft was used in 11 patients. In 9 patients with vascularized sural nerve grafts, a skin flap or adipofascial flap harvested with the vascularized sural nerve was used to cover or fill the soft tissue defect. Postoperative radiotherapy was applied in 8 patients. We evaluated the results using Yanagihara's 40-points grading system after more than ten months' follow-up. Eight patients reconstructed by vascularized nerve grafts obtained 20 and 32 points (average 25.3) , and 4 patients reconstructed by free nerve grafts obtained 14 and 36 points (average 22.0) . The average scores of the patients with total facial nerve defects were 25.0 and 14.0 points in the vascularized and free nerve graft groups, respectively. However, no significant differences were identified between these two groups. Problems encountered were obvious misdirections of the facial nerve in 2 patients with total facial nerve defects. These results indicated that a vascularized sural nerve graft is preferable for a reliable result when a flap to cover or fill a soft tissue defect is required, because it can be elevated with a skin flap from the posterior calf region.