Cirugía reparadora de la parálisis facial mediante colgajo libre microvascularizado de músculo gracilis / Facial reanimation surgery with micro-vascular gracilis free flap for unilateral facial palsy

Introducción/objetivos: La transferencia de colgajo libre muscular microneurovascular es actualmente el procedimiento de elección para la parálisis facial de larga evolución. Presentamos una serie de casos de pacientes tratados con colgajo libre de músculo gracilis con inervación motora por el nervio maseterino. Se analiza la técnica quirúrgica y cuantificamos el movimiento otorgado por el músculo, así como la mejoría en la calidad de vida y los resultados estéticos obtenidos. Materiales y métodos: Se analizan 10 pacientes con parálisis facial unilateral, quienes fueron intervenidos con colgajo muscular libre gracilis, durante los años 2010 y 2012 en 2 centros hospitalarios de tercer nivel. Resultados: No encontramos fallo de la microsutura con supervivencia de todos los colgajos realizados. El movimiento muscular se cuantificó mediante vectores en reposo y contracción, con un promedio de 1,7 cm, se inició aproximadamente hacia el cuarto mes después de la intervención. Se demuestra también una mejoría significativa de la simetría en reposo, así como de la competencia oral y ocular. Conclusiones: Como se presenta actualmente en la literatura los colgajos libres microvascularizados son la técnica de elección para la reanimación facial. En nuestra experiencia consideramos que el colgajo con músculo gracilis inervado por el nervio maseterino es una técnica fiable y segura, que ofrece adecuados resultados tanto funcionales como estéticos (AU)

Introduction and objectives: Micro-neurovascular free muscle flap transfer is currently the procedure of choice for long-standing facial paralysis. We present a case series of patients treated with gracilis muscle free flap with motor innervation by the masseteric nerve. We discuss the surgical technique and quantify the movement granted by the muscle, the improvement in quality of life and aesthetic results. Materials and methods: We report ten patients with unilateral facial paralysis who underwent free gracilis muscle flap, between the years 2010 and 2012 in two tertiary hospitals. Results: It is not reported any failure of the microsuture with survival of all flaps. The muscle movement was quantified by vectors at rest and contraction with an average of 1.7 cm that initiated around the fourth month after surgery. Patients also reported a significant improvement in symmetry at rest as well as oral and ocular competition. Conclusion: As currently presented in literature, microvascular free flaps are the technique of choice for facial reanimation. In our experience, we believe that gracilis muscle flap innervated by the masseteric nerve is a reliable and secure technique that provides adequate functional and aesthetic results (AU)

Facial reanimation surgery with micro-vascular gracilis free flap for unilateral facial palsy.

INTRODUCTION AND OBJECTIVES: Micro-neurovascular free muscle flap transfer is currently the procedure of choice for long-standing facial paralysis. We present a case series of patients treated with gracilis muscle free flap with motor innervation by the masseteric nerve. We discuss the surgical technique and quantify the movement granted by the muscle, the improvement in quality of life and aesthetic results. MATERIALS AND METHODS: We report ten patients with unilateral facial paralysis who underwent free gracilis muscle flap, between the years 2010 and 2012 in two tertiary hospitals. RESULTS: It is not reported any failure of the microsuture with survival of all flaps. The muscle movement was quantified by vectors at rest and contraction with an average of 1.7 cm that initiated around the fourth month after surgery. Patients also reported a significant improvement in symmetry at rest as well as oral and ocular competition. CONCLUSION: As currently presented in literature, microvascular free flaps are the technique of choice for facial reanimation. In our experience, we believe that gracilis muscle flap innervated by the masseteric nerve is a reliable and secure technique that provides adequate functional and aesthetic results.