One-stage reanimation of the paralyzed face using the rectus abdominis neurovascular free flap.
BACKGROUND
Functional free muscle transfer for the surgical correction of long-standing facial paralysis has gained validity over the past three decades. These traditionally multistep reconstructions often achieve clinical success, but at the cost of significant morbidity and lengthy recovery periods. To address this dilemma, the authors propose reconstruction using the rectus abdominis and accompanying intercostal nerve in a one-stage neurovascular free flap reanimation procedure.


METHODS
Between 1998 and 2001, five patients with long-standing unilateral facial paralysis at the University of Pittsburgh Facial Nerve Center underwent reanimation using the authors' protocol. Preoperative and postoperative assessments included clinical evaluation using the Facial Grading System and electromyography. The patients were followed for a mean of 16 months.


RESULTS
At the final postoperative visit, all five patients demonstrated improved levator electromyographic potential, with a median 67 percent improvement. All five patients further demonstrated an increase in zygomaticus electromyographic potential, with a median 225 percent improvement. All five patients demonstrated increased Facial Grading System score at most recent follow-up.


CONCLUSIONS
The one-step reanimation using free rectus abdominis neurovascular free flap demonstrated a consistent positive outcome in electromyographic and clinical assessments. The additional benefits of reduced recovery time and anatomical reliability of the flap render the authors' method preferable to other traditional methods of surgical reanimation of the paralyzed face.
Sajjadian
Ali
A
Division of Plastic and Reconstructive Surgery, Department of Physical Therapy, School of Health and Rehabilitative Sciences, University of Pennsylvania, Pittsburgh, PA, USA. asajadian@aol.com
Song
Angela Y
AY
Khorsandi
Christopher A
CA
Deleyiannis
Frederic W B
FW
VanSwearingen
Jessie M
JM
Henkelmann
Todd C
TC
Hui
Kenneth
K
Manders
Ernest K
EK
D004576:Electromyography; D005158:Facial Paralysis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods; D017568:Rectus Abdominis; D013524:Surgical Flaps; D013536:Suture Techniques; D015050:Zygoma / Q000601:surgery