Smile reconstruction using one-stage transfer of the latissimus dorsi muscle

Abstract

The two-stage method combining neurovascular free-muscle transfer with cross-facial nerve grafting has promised a natural or near-natural reanimation of the paralyzed face. Its chief drawbacks, however, are the lengthy period for recovery, including two operations 10 to 12 months apart, and morbidity associated with harvesting a sural nerve segment such as conspicuous scar, hypoesthesia, or paraesthesia in the donor leg. To overcome the drawbacks of the two-stage method, we developed a one-stage transfer of a latissimus dorsi muscle segment in which a long thoracodorsal nerve is crossed through the upper lip and hooked up to the contralateral healthy facial nerve branches. Reinnervation of the transferred muscle is established at a mean of 7 months postoperatively, which is faster than that of the two-stage method. We also obtained good results in more than 80% of 82 patients (September 1993 through December 1997), which compares well with the results of the two-stage method. Operative details and representative results of this procedure are introduced in this article.