title: Fifteen-year survey of one-stage latissimus dorsi muscle transfer for treatment of longstanding facial paralysis.
abstract: BACKGROUND
  Neurovascular free muscle transfer is one of the main reconstructive options for established or long-standing facial paralysis. The two-stage gracilis muscle transfer combined with the cross-face nerve graft (two-stage method) has been supplanted by one-stage reconstruction using the latissimus dorsi muscle (LD) at our institution. This study retrospectively evaluated the results of one-stage LD transfer.
  
  
  METHODS
  Between September 1993 and December 2008, 344 patients (133 males, 211 females; age range, 5-75 years) with unilateral facial paralysis underwent 351 one-stage LD transfers. Patients were evaluated with a custom grading scale. Differences in grading scale score were compared according to age, past surgical history and the duration from operation to neuromuscular recovery.
  
  
  RESULTS
  Contraction of the transferred muscle was recognised in 305 (87.0%) transfers. The duration until neuromuscular recovery ranged from 3 to 16 months (average ± standard deviation: 6.48 ± 1.92 months). The grading scale was significantly lower in middle-age group than in younger and elder groups (P < 0.01). Duration until neuromuscular recovery was significantly different when comparing the younger group and the oldest group. There was no difference in grading scale score or in duration until neuromuscular recovery when comparing the patients with a past surgical history and those without. The grading scale negatively correlated with the duration until neuromuscular recovery.
  
  
  CONCLUSIONS
  The results are consistent and statistical analysis revealed the versatility of the one-stage LD transfer. Although we believe the two-stage method is still a good option for facial reanimation, the one-stage method is advantageous regarding the shorter period of recovery and little donor-site morbidity.
authors.affiliation: Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan. takushima-pla@umin.ac.jp
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takushima
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Harii
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Asato
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kurita
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shiraishi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002610:Cheek / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005154:Facial Nerve / Q000601:surgery; D005158:Facial Paralysis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000098:blood supply / Q000294:innervation* / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012904:Smiling / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult