One-stage dual latissimus dorsi muscle flap transfer with a pair of vascular anastomoses and double nerve suturing for long-standing facial paralysis

摘要: Summary Objective Various types of neurovascular free-muscle transfers have been reported as surgical treatments for long-standing facial paralysis. Among one-stage methods, two approaches, that is, latissimus dorsi transfer with nerve suturing to the contralateral and gracilis ipsilateral masseteric nerve, recently become popular. The former method has advantage making spontaneous smiling possible, but contraction strength transferred muscle varies, whereas latter approach guaranteeing voluntary muscle, makes difficult. Recently, dual innervation methods also reported, uncertainty remains about utility such approaches. To overcome these drawbacks, we devised a hybrid combining previously established techniques. Methods Two flaps containing thoracodorsal vessels from one side are pair vascular anastomoses. true trunk which innervates flaps, is sutured while short branch other flap, nerve. From November 2011 October 2013, used this in four patients Results Smiling was assessed three who were followed up more than 1 year, satisfactory results obtained (Harii score: 4–5). In patient, movement mediated via little weak, compensated by muscles controlled Conclusion Our novel method, involves combination guarantees early smiling, becomes possible later. addition, it free associated double does not require grafts. So, stable can be expected most