An Algorithm to Guide Recipient Vessel Selection in Cases of Free Functional Muscle Transfer for Facial Reanimation

 

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Background The aim of this study was to review the recipient vessels used in our cases of facial reanimation with free functional muscle transfer and to identify patient variables that may predict when the facial vessels are absent. From this we present a protocol for vessel selection in cases when the facial artery and/or vein are absent.

Methods Patients were identified from November 2006 to October 2013. Data was collected on patient demographics, facial palsy aetiology, history of previous facial surgery/trauma and flap/recipient vessels used. A standard operative approach was adopted and performed by a single surgeon.

Results Eighty-seven eligible patients were identified for inclusion amongst which 98 hemifaces were operated upon. The facial artery and vein were the most commonly used recipient vessels (90% and 83% of patients, respectively). Commonly used alternative vessels were the transverse facial vein and superficial temporal artery. Those with congenital facial palsy were significantly more likely to lack a suitable facial vein (P=0.03) and those with a history of previous facial surgery or trauma were significantly more likely to have an absent facial artery and vein (P<0.05).

Conclusions Our algorithm can help to guide vessel selection cases of facial reanimation with free functional muscle transfer. Amongst patients with congenital facial palsy or in those with a previous history of facial surgery or trauma, the facial vessels are more likely to be absent and so the surgeon should then look towards the transverse facial vein and superficial temporal artery as alternative recipient structures.

This article was presented at the European Society of Plastic, Reconstructive and Aesthetic Surgeons Meeting on July 7, 2014 in Edinburgh, UK.

Publication History

Received: 30 July 2014

Accepted: 13 October 2014

Article published online:
05 May 2022

© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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• References

• 1 Ghali S, MacQuillan A, Grobbelaar AO. Reanimation of the middle and lower face in facial paralysis: review of the literature and personal approach. J Plast Reconstr Aesthet Surg 2011; 64: 423-431
  CrossrefPubMedGoogle Scholar
• 2 Thompson N. Autogenous free grafts of skeletal muscle. A preliminary experimental and clinical study. Plast Reconstr Surg 1971; 48: 11-27
  CrossrefPubMedGoogle Scholar
• 3 Harii K, Ohmori K, Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg 1976; 57: 133-143
  CrossrefPubMedGoogle Scholar
• 4 Harrison DH, Grobbelaar AO. Pectoralis minor muscle transfer for unilateral facial palsy reanimation: an experience of 35 years and 637 cases. J Plast Reconstr Aesthet Surg 2012; 65: 845-850
  CrossrefPubMedGoogle Scholar
• 5 Lohn JW, Penn JW, Norton J. et al. The course and variation of the facial artery and vein: implications for facial transplantation and facial surgery. Ann Plast Surg 2011; 67: 184-188
  CrossrefPubMedGoogle Scholar
• 6 MacQuillan A, Horlock N, Grobbelaar A. et al. Arterial and venous anatomical features of the pectoralis minor muscle flap pedicle. Plast Reconstr Surg 2004; 113: 872-876
  CrossrefPubMedGoogle Scholar
• 7 Niranjan NS. An anatomical study of the facial artery. Ann Plast Surg 1988; 21: 14-22
  CrossrefPubMedGoogle Scholar
• 8 Koh KS, Kim HJ, Oh CS. et al. Branching patterns and symmetry of the course of the facial artery in Koreans. Int J Oral Maxillofac Surg 2003; 32: 414-418
  CrossrefPubMedGoogle Scholar
• 9 Houseman ND, Taylor GI, Pan WR. The angiosomes of the head and neck: anatomic study and clinical applications. Plast Reconstr Surg 2000; 105: 2287-2313
  CrossrefPubMedGoogle Scholar
• 10 Renshaw A, Whitwell KA, Berger L. et al. The use of color Doppler ultrasound in the assessment of vessels for facial transplantation. Ann Plast Surg 2007; 59: 82-86
  CrossrefPubMedGoogle Scholar
• 11 Yang HJ, Gil YC, Lee HY. Topographical anatomy of the transverse facial artery. Clin Anat 2010; 23: 168-178
  PubMedGoogle Scholar
• 12 Soikkonen K, Wolf J, Hietanen J. et al. Three main arteries of the face and their tortuosity. Br J Oral Maxillofac Surg 1991; 29: 395-398
  CrossrefPubMedGoogle Scholar
• 13 Chen TH, Chen CH, Shyu JF. et al. Distribution of the superficial temporal artery in the Chinese adult. Plast Reconstr Surg 1999; 104: 1276-1279
  CrossrefPubMedGoogle Scholar
• 14 Bianchi B, Copelli C, Ferrari S. et al. Facial animation with free-muscle transfer innervated by the masseter motor nerve in unilateral facial paralysis. J Oral Maxillofac Surg 2010; 68: 1524-1529
  CrossrefPubMedGoogle Scholar
• 15 Takushima A, Harii K, Asato H. et al. Neurovascular free-muscle transfer for the treatment of established facial paralysis following ablative surgery in the parotid region. Plast Reconstr Surg 2004; 113: 1563-1572
  CrossrefPubMedGoogle Scholar
• 16 Takushima A, Harii K, Asato H. et al. Neurovascular free-muscle transfer to treat facial paralysis associated with hemifacial microsomia. Plast Reconstr Surg 2002; 109: 1219-1227
  CrossrefPubMedGoogle Scholar
• 17 Nahabedian MY, Singh N, Deune EG. et al. Recipient vessel analysis for microvascular reconstruction of the head and neck. Ann Plast Surg 2004; 52: 148-155
  CrossrefPubMedGoogle Scholar
• 18 Takamatsu A, Harashina T, Inoue T. Selection of appropriate recipient vessels in difficult, microsurgical head and neck reconstruction. J Reconstr Microsurg 1996; 12: 499-507
  Article in Thieme ConnectPubMedGoogle Scholar
• 19 Shimizu F, Lin MP, Ellabban M. et al. Superficial temporal vessels as a reserve recipient site for microvascular head and neck reconstruction in vessel-depleted neck. Ann Plast Surg 2009; 62: 134-138
  CrossrefPubMedGoogle Scholar
• 20 Chia HL, Wong CH, Tan BK. et al. An algorithm for recipient vessel selection in microsurgical head and neck reconstruction. J Reconstr Microsurg 2011; 27: 47-56
  Article in Thieme ConnectPubMedGoogle Scholar
• 21 Nagata S. A new method of total reconstruction of the auricle for microtia. Plast Reconstr Surg 1993; 92: 187-201
  CrossrefPubMedGoogle Scholar
• 22 Schusterman MA, Miller MJ, Reece GP. et al. A single center's experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg 1994; 93: 472-478
  CrossrefPubMedGoogle Scholar
• 23 Jones NF, Johnson JT, Shestak KC. et al. Microsurgical reconstruction of the head and neck: interdisciplinary collaboration between head and neck surgeons and plastic surgeons in 305 cases. Ann Plast Surg 1996; 36: 37-43
  CrossrefPubMedGoogle Scholar
• 24 Podrecca S, Salvatori P, Squadrelli Saraceno M. et al. Review of 346 patients with free-flap reconstruction following head and neck surgery for neoplasm. J Plast Reconstr Aesthet Surg 2006; 59: 122-129
  CrossrefPubMedGoogle Scholar
• 25 Zhao Z, Li S, Xu J. et al. Color Doppler flow imaging of the facial artery and vein. Plast Reconstr Surg 2000; 106: 1249-1253
  CrossrefPubMedGoogle Scholar