title: Double innervated free functional muscle transfer for facial reanimation.
abstract: BACKGROUND
  The treatment of long-standing facial palsy represents a challenge for the reconstructive surgeon. Treatment is based on dynamic procedures such as functional muscle flaps. The benefit of added axonal load has recently been reported. This study describes a two stage technique involving dual innervation of a gracilis muscle flap with initial cross-facial nerve graft (CFNG) followed by free muscle transfer co-apted to both the CFNG and a masseter nerve for facial reanimation.
  
  
  METHODS
  A total of nine patients from August 2008-July 2011 were operated on with the double innervated gracilis muscle flap. Pre- and postoperative electromyography was documented, and video analysis with the five-stage classification of reanimation outcomes was performed.
  
  
  RESULTS
  All patients recovered voluntary and spontaneous smile abilities, with an average of 70% motor unit recruitment. Based on the Terzis reanimation outcome classification, four patients had an excellent result, four good, and one moderate.
  
  
  CONCLUSIONS
  The double innervated gracilis muscle flap is a viable technique for the treatment of long-standing facial palsy. It enables a fast recovery with fast muscle activity, and allows an emotional smile and aesthetic symmetry.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Hospital General Dr. Manuel Gea Gonzalez , Mexico City , Mexico.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cardenas-Mejia
authors.forename: Jorge Vladimir
authors.initials: JV
authors.lastname: Covarrubias-Ramirez
authors.forename: Andres
authors.initials: A
authors.lastname: Bello-Margolis
authors.forename: Shai
authors.initials: S
authors.lastname: Rozen
mesh_terms: D000293:Adolescent; D000328:Adult; D005152:Facial Muscles / Q000637:transplantation*; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D055815:Young Adult
keywords: Facial palsy; babysitter; facial reanimation; gracilis muscle flap