title: Functioning free gracilis myocutaneous flap transfer provides a reliable single-stage facial reconstruction and reanimation following tumor ablation.
abstract: BACKGROUND
  Ablative orofacial defects incorporating mimetic facial musculature/nerve cause hemifacial expressive dysfunction and considerable morbidity but are rarely reanimated immediately using free functioning gracilis myocutaneous flaps.
  
  
  METHODS
  Disrupted buccal branches provided a recipient facial nerve for 24 gracilis reinnervations. An additional 15 free flaps were used for extensive composite defects. Smile outcome was graded according to Terzis' criteria after 2 years of recurrence-free follow-up. The effects of postoperative radiotherapy, integrity of the oral commissure, and double free flaps were compared.
  
  
  RESULTS
  Eighteen patients completed 2 years' recurrence-free follow-up; average smile outcome was Terzis grade 4 (mean, 3.8). Resection/reconstruction of the modiolus (five of 18 patients) tended to diminish outcome (Terzis grade 3, mean, 3.0; median, 3; versus Terzis grade 4, mean, 4.1; median, 5) compared with two free flaps performed simultaneously(mean, 3.56 versus 4.14; median, 3 versus 5). Postoperative radiotherapy (eight of 18 patients) had a more modest effect on outcome (Terzis grade 3, mean, 3.3; Terzis grade 4, mean, 4.1; median, 3 versus 5).
  
  
  CONCLUSIONS
  Reconstruction of oncologic defects including expressive facial musculature/nerve with gracilis free functioning muscle transfer can restore oral continence and facial expression primarily.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Taoyuan, Taiwan From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Lin
authors.forename: Christopher
authors.initials: C
authors.lastname: Wallace
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
mesh_terms: D000328:Adult; D016025:Bone Transplantation; D002610:Cheek / Q000601:surgery*; D004954:Esthetics; D005152:Facial Muscles / Q000294:innervation / Q000601:surgery; D005153:Facial Neoplasms / Q000473:pathology / Q000601:surgery*; D020220:Facial Nerve Injuries / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation / Q000637:transplantation*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012904:Smiling / Q000502:physiology