Double innervation (facial/masseter) on the gracilis flap, in the middle face reanimation in the management of facial paralysis: A new concept

作者：Biglioli F; Bayoudh W^*; Colombo V; Pedrazzoli M; Rabbiosi D

来源：Annales de Chirurgie Plastique Esthetique, 2013, 58(2): 89-95.

DOI：10.1016/j.anplas.2012.12.001

• Facial paralysis
• Dual innervation
• Gracilis flap

Introduction. - The facial paralysis is a non-rare condition that has very disabling functional, morphological and psychological repercussions. The current gold standard in facial reanimation is revascularized re-innervated muscle transfers. %26lt;br%26gt;Materials and methods. - In this paper, we report the results of a new method using the gracilis flap with a double innervation on the masseter motor nerve and the controlateral facial nerve via a sural graft in a single stage intervention, on a series of six patients. %26lt;br%26gt;Results. - No failure was observed. The average delay of a voluntary contraction was 3.8 months, and 7.2 months for a spontaneous one. Three of the six patients had %26quot;excellent%26apos;%26apos; results according to the Terzis and Noah classification, two were classified as %26quot;good%26apos;%26apos; and one %26quot;average%26apos;%26apos;. %26lt;br%26gt;Discussion. - A choice is to be made between a method advocating a natural and spontaneous dynamicity (controlateral facial nerve stimulus) and a method focusing on the quality and quantity of contractions (ipsilateral trijeminal stimulus). In this new technique, we combine the two methods: a free gracilis transfer with a dual innervation on the healthy controlateral facial nerve via a sural graft, on one hand, and a second anastomosis on the ipsilateral masseter nerve, on the other hand. %26lt;br%26gt;Conclusion. - This new proposed method seems to be, according to our results, a reliable technique rallying voluntary contraction and emotional smile.

• 出版日期2013-4