Gracilis Muscle Research Articles

The gracilis flap is a versatile muscle flap that can be utilized as a muscle only or myocutaneous flap for soft tissue coverage, as well as for reconstruction of facial animation or extremity function. Few studies have compared donor site complications of free and pedicled gracilis flaps, including the effect of skin paddle harvest on donor site morbidity. We performed a retrospective review of patients who underwent a free or pedicled gracilis flap at our institution from 2013-2023. Gracilis flaps were categorized as: pedicled gracilis muscle flaps used for vaginectomy in gender reaffirming surgery, free gracilis muscle flaps, and free gracilis myocutaneous flaps. Outcome variables were duration of drain placement and complications including seroma, hematoma, infection, dehiscence, and persistent numbness. We identified 128 gracilis flaps including 19 free myocutaneous flaps, 35 free muscle flaps, and 74 pedicled muscle flaps. Free myocutaneous flaps required longer drain placement as compared to free muscle flaps or pedicled flaps (13.6 vs 8.4 vs 7.4 days, respectively, p=0.002). Free myocutaneous flaps displayed a higher complication rate (36.8%) as compared to pedicled muscle flaps (10.8%), or free muscle flaps (11.4%, p=0.020). After adjusting for age, BMI, and ASA status, free myocutaneous flaps demonstrated higher odds of major donor site complication as compared to pedicled muscle flaps (OR 1.23, p<0.001), while free muscle flaps were not associated with increased odds of major complication (OR 1.08, p=0.117). Of the documented complications, the most common were surgical site infection (36.8%), hematoma (21.1%) and seroma (21.1%). The inclusion of a skin paddle during gracilis flap harvest is associated with increased duration of drain placement and donor site complications including surgical site infection, hematoma, and seroma. These factors should be carefully considered in the context of patients' reconstructive needs and other risk factors.

SNUPN-related muscular dystrophy or LGMDR29 is a new entity that covers from a congenital or childhood onset pure muscular dystrophy to more complex phenotypes combining neurodevelopmental features, cataracts, or spinocerebellar ataxia. So far, 12 different variants have been described. Here we report the first family with SNUPN-related muscular dystrophy presenting an adult-onset myopathy as well as novel ultrastructural findings. Clinical evaluation, muscle and brain magnetic resonance imaging (MRI), and muscle histopathological and electron microscopy analysis were conducted. Functional studies including protein modelling and interaction, immunofluorescence and splicing analysis were also performed. Two siblings carrying two novel deleterious variants in the SNUPN gene (p.Arg27Cys and p.Cys174Tyr) showed adult-onset proximo-distal and axial muscle weakness with early respiratory involvement. One patient presented with asymptomatic cerebellar atrophy. Muscle MRI identified involvement in the paravertebral, triceps brachii, sartorius and gracilis muscles. The histopathology revealed dystrophic changes and an abnormal pattern of cytoskeletal and myofibrillar proteins, while electron microscopy disclosed the proliferation of granules and vesicles associated with features of nuclear envelope and sarcolemma remodelling. Functional studies showed that SNUPN variants impair snurportin-1 function through reduced binding affinity to importin-β and impaired folding, leading to disturbed nuclear import of small nuclear ribonucleoproteins and downstream splicing. Our work expands the phenotype of SNUPN-related muscular dystrophy and provides more insights into their pathological profile. We advise SNUPN testing in patients with late-onset proximo-distal and axial weakness with early respiratory impairment and features reminding inclusion body myositis (IBM). Granular deposits suggestive of biomolecular condensates perturbed cell organelle traffic and membrane homeostasis, opening new avenues to understand the pathomechanisms involved in this novel disease.

Spasticity results from upper motor neuron lesions and can create a deforming force and pain, and is often accompanied by contracture. Although the origin of spasticity is neural, there is ample evidence of secondary muscle changes. Here, we use direct measurement of the force-frequency relationship (FFR) to characterize human muscle's physiological properties. This study directly quantified the FFR of both healthy and spastic human skeletal muscles. Muscle force was measured intraoperatively in healthy gracilis (n = 13; aged 39.4 ± 10.6 yr; surgery due to brachial plexus injury) and spastic biceps brachii muscle (n = 8; aged 53.3 ± 10.3 yr; surgery due to stroke or traumatic brain injury). Nerve stimulation was applied at frequencies ranging from 1 to 70 Hz. Twitch contraction parameters, including time to peak tension (TPT) and half-relaxation time (HRT), were also compared. The FFR of the two muscles was modeled with sigmoid functions, and differences between muscles were assessed with an extra sum-of-squares F test. TPT did not significantly differ between groups (P = 0.12), whereas HRT was prolonged in the spastic biceps (P < 0.05). Despite small differences in twitch kinetics, both muscles exhibited nearly identical FFR profiles. This study represents the first direct in vivo report of spastic human muscle kinetic properties and shows that these contractile kinetics are similar in healthy and spastic muscles. This may suggest that there are no dramatic calcium handling or myosin heavy chain changes in the biceps muscle secondary to spasticity.NEW & NOTEWORTHY This study presents the first in vivo intraoperative measurement of the kinetic properties of spastic human muscle. Despite slower relaxation in spastic biceps, the force-frequency relationship was similar to that of the healthy gracilis muscle. This suggests that spasticity does not substantially alter frequency-dependent force summation, possibly due to similar fiber-type compositions and limited changes in calcium handling or myosin isoforms in human spastic muscle.

Background: Fournier gangrene is a polymicrobial soft tissue infection of the genito-perineal region of the body. It is relatively rare but life-threatening. Objective: This study aimed to discuss the management and outcome of Fournier gangrene. Materials and Methods: The records of patients managed as cases of Fournier gangrene between 2020 and 2024 were retrieved from the hospital medical record department. The information collated from these files includes socio-demographic data, clinical features, modality, and treatment outcome. Descriptive analysis was done using SPSS version 23. Results: Although 15 patients were admitted and managed as Fournier gangrene, only 13 patients had complete data and were analyzed. The age distribution was between 21-80 years, with a mean of 41.1 ± 15.7 SD. All the patients were male, and all of them presented in emergency with clinical features of sepsis identified in 3 patients. The wound culture of the remaining 7 patients (53.8%) could not be retrieved. The investigated subjects ' Fournier gangrene severity index (FGSI) score showed a range of 2-12 with a mean of 7.6 ± 3.1 SD. Concerning definitive wound care, six patients (46.2%) had spontaneous wound closure due to the relatively small size of the defect. Five patients (38.5%) had primary wound closure under spinal anesthesia. The remaining two patients with FGSI scores of 9 and 11 underwent reconstructive procedures: scrotal advancement flaps + gracilis muscle flap + split-thickness skin graft. Conclusion: The average FGSI score was 7. There was no mortality. The most commonly involved part was the scrotum, while the rarest was the penis. Prompt response and adequate resuscitation are required for good outcomes, as observed in this study.

Introduction: Anterior cruciate ligament (ACL) tears are among the most common knee injuries. These injuries compromise stability and function, frequently requiring surgical reconstruction. Understanding how postural control of the lower limb is affected in patients undergoing ACL reconstruction (ACLR) with different techniques, under the same rehabilitation protocol, is essential for optimizing recovery and improving functional outcomes after physical therapy. Objective: Compare the rehabilitation protocol effectiveness on postural control between the ACLR technique Bone-Tendon-Bone (BTB) and graft extracted from the semitendinosus and gracilis muscles (STG). Methodology: Posturographic evaluation was performed 16 weeks after surgery with a 16-week standardized rehabilitation protocol in a BTB group (n=30, age=32,16±8,73 years, weight=78,03±9,53 kg, height=1,69±0,06 m) and another STG group (n=38; age=34,84±9,4 years; weight=76,47±9,27 kg; height=1,67±0,05 m). Results: The investigation shows that there are no statistically significant differences in unilateral velocity (p&gt;0.05) and unilateral area of the center of pressure (p&gt;0.05) in subjects with ACLR using the BTB technique. Discussion: Two ACLR techniques were compared under the same 16-week rehabilitation protocol, evaluating balance and postural stability. The results showed that the BTB technique presented less difference between the injured and healthy limbs, demonstrating better results than the STG graft. However, methodological limitations were identified, as well as the need to consider factors such as limb dominance in future research. Conclusions: The BTB reconstruction technique presents better postural control results in patients undergoing 16 weeks of physiotherapy.

Modified free functional split gracilis flap design for periorbital and perioral smile reanimation in patients with total flaccid facial paralysis: A cadaveric study.

Facial nerve palsy in children leads to significant functional impairment and facial asymmetry. While free gracilis muscle transfer (FGMT) is a cornerstone technique for smile reanimation in both pediatric and adult patients, its evaluation has mainly focused on the single metric of commissure excursion. This study seeks to evaluate the effectiveness of FGMT in restoring dynamic smiles in pediatric patients with facial palsy using image analysis.A retrospective review was conducted in children who underwent FGMT for facial palsy at a major children's hospital between 2007 and 2020. Data collection included pre- and postoperative chart reviews and image analysis. Anthropometric measurements were obtained using a machine learning-based smile analysis software. Primary outcomes included commissure excursion, commissure angle, dental show, and smile symmetry. Statistical analysis was performed using the Wilcoxon signed-rank test.A total of 31 patients with an average age of 10 years underwent FGMT for smile reanimation during the study period. The most common diagnosis was Moebius syndrome (48%). Donor nerves for gracilis neurotization included 18 ipsilateral trigeminal nerves (58.1%) and 12 contralateral facial nerves via cross-face sural nerve grafts (38.7%). Overall, 84% of patients demonstrated active gracilis contraction within a mean of 2.5 years postoperative follow-up. Commissure excursion increased by 9.7 mm at 1 year (p < 0.05), and symmetry significantly improved for commissure height, commissure excursion, upper lip height, and smile angle. There were no significant improvements in dental show, commissure angle, symmetry of dental show, and lower lip height. Furthermore, only 16% of patients demonstrated clinically symmetric smiles within the follow-up period.While FGMT effectively restores commissure excursion in pediatric patients with facial palsy, achieving multidimensional smile reanimation remains a challenge. New techniques in multi-vector free tissue transfer may help optimize FGMT outcomes in pediatric patients.

The role of plastic surgeons in urologic reconstruction following malignancy and trauma remains poorly defined despite potential synergies in complex cases requiring specialized reconstructive techniques. Systematic literature search of PubMed, Medline/Ovid, and Cochrane databases using predetermined search terms combining "plastic surgery" with urologic cancer and trauma keywords. Studies were included if both urologic and plastic surgeons were involved in clinical care. Four studies met inclusion criteria from 46 initial references, representing diverse applications from 2021 to 2025. Key findings included the following: (1) complex abdominal wall reconstruction following retroperitoneal sarcoma resection using biologic mesh and omental flaps; (2) plastic surgery involvement in 33% of scrotal squamous cell carcinoma and 67% of extramammary Paget's disease cases undergoing Mohs surgery with low recurrence rates; (3) microsurgical lymphovenous bypass for lymphedema following inguinal lymphadenectomy in penile cancer patients; and (4) gracilis muscle flap interposition for rectourethral fistula repair, demonstrating significantly improved healing rates with systematic multidisciplinary protocols (100% vs 66%, P = 0.04). Limited but compelling evidence supports plastic surgery involvement in complex urologic reconstruction, particularly for extensive oncologic resections, scrotal malignancies, lymphedema management, and complex fistula repair. Systematic multidisciplinary approaches demonstrate improved outcomes, although further research is needed to establish optimal protocols and cost-effectiveness.

Lawn mower injuries can cause limb-threatening wounds in the lower extremities of children. Although most cases require only basic wound treatment, a minority need microsurgical and orthopedic reconstruction for limb salvage. These procedures remain complex owing to small vessel diameter, increased vasospasticity, limited postoperative compliance, and continued growth in children. This case series demonstrated successful microsurgical foot reconstructions in a selected pediatric patient cohort. Three patients younger than 5 years underwent foot reconstruction after mower injury. Injury patterns included (1) Chopart-like forefoot amputation, (2) first toe amputation, and (3) amputation of metatarsals I and II with destruction of the third toe, each with respective soft tissue defects. One patient required hindfoot reconstruction and tendon transfers before microsurgery. Two patients received latissimus dorsi flaps, and 1 was treated with a gracilis muscle flap. Functional outcomes were assessed using the Lower Extremity Functional Scale. Patients were aged 2, 3, and 5 years, with reconstruction performed 1-24 days postinjury. All 3 patients underwent successful microsurgical and orthopedic reconstruction with no major complications. All patients presented with preserved ability to walk and participate in sports, achieving Lower Extremity Functional Scale scores of 75-80 out of 80, even after a maximum follow-up of 20 years. Foot reconstructions after traumatic foot amputation in children are intricate procedures. Nonetheless, microvascular reconstruction is a feasible option for limb salvage in pediatric patients even at ages as young as 2 years. Interdisciplinary cooperation is essential to provide a comprehensive treatment concept and restore optimal functionality.

Genital degloving injuries are rare and mainly occur due to industrial machine accidents affecting workers at their places of employment. Most cases of genital degloving result in the loss of function—both urination and sexual capability—as well as the appearance of the genital organs. Immediate treatment is essential for minimising infection and necrosis, and it is also important for addressing potential psychological distress and preserving fertility. This case report presents an Indian factory worker, aged 24 years, who sustained severe penile and scrotal degloving injuries from a textile roller machine accident. Upon arrival, the patient exhibited no significant blood pressure disturbances but required urgent surgical intervention due to the exposure of his testicles and the complete separation of his penile skin from his body. The initial treatments included fluid resuscitation, broad-spectrum antibiotics, tetanus prophylaxis, analgesics, and surgical debridement. Reconstruction was carried out after serial debridement procedures resulted in a granulating wound surface. This allowed the surgeons to utilise a left gracilis muscle flap to cover the exposed testes. Vacuum-Assisted Closure (VAC) therapy promoted both wound healing and effective graft integration at the surgical site. The patient experienced a smooth postoperative recovery, as the skin flap survived without any complications, effectively preventing infection. Semen analysis conducted after the surgical intervention confirmed that spermatogenesis remained normal, indicating successful testicular recovery. This case highlights the necessity of strengthening workplace safety requirements to prevent accidents. It also demonstrates that gracilis flap surgery combined with VAC therapy yields positive outcomes in both health and aesthetic recovery. The preservation of fertility should be prioritised for all young adult males who sustain genital trauma.

Abstract Complex vulvar defects are challenging owing to their three-dimensional characteristics. We introduce a combined flap approach to maximize the use of locoregional tissues. Four patients had defects involving the vaginal wall, anal canal, and perineum, with a size range of 108 to 157 cm2. The outcomes were analyzed using a questionnaire regarding micturition, defecation, coital function, introitus opening, and aesthetics. For the vulva, the gluteal fold flap was the primary flap, which was augmented by the mons pubis rotation flap, gracilis muscle flap, pudendal thigh flap, and medial thigh VY advancement flap. The perianal skin and anal defects were covered by the gluteal fold and buttock VY advancement flaps. Patients' satisfaction scores were favorable on follow-up. Our multi-flap approach optimized the aesthetic and functional results of combined vulvar–anal defects.

Brachial plexus injuries (BPI) can be devastating for patients, often resulting in notable physical, psychological, and socioeconomic distress1. Violent accidents that torque the head away from the shoulder frequently damage the upper brachial plexus roots, with varying severity of damage to the lower roots1. Patients having pan-plexus injuries typically present with a flail extremity, loss of sensory function, and generalized atrophy. To improve activities of daily living, the treatment of pan-plexus injuries focuses on restoring antigravity motion of the upper extremity, with elbow flexion being a high priority muscle group2. Although nerve transfers are an excellent option, this treatment path is not always viable. In such cases, free functioning muscle transfers, especially gracilis transfers, have emerged as a primary reconstructive approach, with excellent outcomes in complete BPI lesions2,3. In this video article, we present the exploration of a complex BPI in which the creation of a gracilis free flap is executed for elbow flexion reconstruction. We provide a comprehensive guide from markings, flap elevation, microsurgical technique, and inset, with educational operative pearls at every step. The procedure involves harvesting the gracilis muscle as a free functioning muscle transfer. The gracilis, which will become a type-II muscle flap, is carefully dissected with its pedicle and nerve preserved. The muscle is then transferred to the upper extremity, where its proximal origin is anchored to the clavicle and its distal tendon is inserted into the biceps tendon with use of a Pulvertaft weave. Vascular anastomoses are performed utilizing branches of the thoracoacromial trunk and venous couplers under a microscope. The muscle is innervated with the spinal accessory nerve and tensioned to ensure optimal elbow flexion. Surgical alternatives include nerve transfers (e.g., Oberlin transfer), tendon transfers, or other free muscle transfers (e.g., latissimus dorsi transfer). Nonsurgical alternatives include orthotic devices to compensate for elbow flexion loss, and physical therapy to maximize existing function. Gracilis free flap transfer is a reliable option for restoring functional elbow flexion in patients with severe BPI when intra-plexal nerve donors are unavailable. Compared with nerve transfers or tendon transfers, gracilis free flap transfer offers consistent outcomes with greater than M3 muscle strength (with M3 indicating movement against gravity but not against resistance, and M4 indicating movement against both gravity and resistance)2. Unlike orthotic devices, this technique provides active elbow flexion, critical for functional independence. The long tendon and reliable vascular pedicle make the gracilis ideal for this purpose. Free flap gracilis muscle transfer for elbow flexion reconstruction has shown promising outcomes in patients with traumatic brachial plexus injuries. Armangil et al. reported that 68.8% of patients achieved M3 or M4 elbow flexion strength, with a median active range of motion of 75° (range, 30° to 100°), and significant improvements in postoperative DASH and SF-36 scores4. De Rezende et al. (2021) demonstrated that 61.9% of patients achieved M4 strength, with 95.2% achieving M2 or higher, and a mean active range of motion of 77° (range, 10° to 110°) across the total cohort5. These findings suggest that free gracilis muscle transfer provides reliable functional improvements, enabling meaningful elbow flexion restoration and enhancing quality of life. Utilize Doppler ultrasound to confirm the location of a skin perforator over the gracilis to aid in postoperative monitoring.Preoperative markings are key. Mark the orientation of the gracilis muscle belly and pedicle preoperatively for efficient harvesting.The gracilis inserts distal to the knee, so extending the knee can help distinguish it from the adductor longus.Preserve all fascia over the gracilis muscle to optimize muscle gliding.Ensure proper resting tension during gracilis insertion to prevent over- or under-tightening, optimize function, and avoid complications like hyperextension or limited flexion.Position the elbow at 90° of flexion and the forearm in supination when tensioning.Make accommodation for any vessel size mismatch between the gracilis pedicle and recipient vessels to minimize complications.Confirm intraoperative vessel patency with use of Doppler flow checks after completing the anastomoses.Confirm nerve viability intraoperatively with use of nerve stimulation, ensuring a strong muscle contraction response.Secure the nerve repair without tension and with the appropriate coaptation in order to maximize reinnervation success.Utilize drains to avoid fluid collections that can create pressure on the pedicle.Place the gracilis tendon insertion precisely with use of the Pulvertaft weave technique, ensuring secure fixation and proper alignment with the biceps tendon. BPI = brachial plexus injuryDASH = Disabilities of the Arm, Shoulder and HandDVT = deep vein thrombosisEMG = electromyographyFFMT = free functioning muscle transferFGMT = free gracilis muscle transferICN = intercostal nerve transferM3/M4 = muscle strength grade 3 or 4MCA = medial circumflex arteryMCN = musculocutaneous nerveNCS = nerve conduction studyPPX = prophylaxisSAN = spinal accessory nerveSF-36 = Short Form-36.

To investigate the clinical effect of transposition of gracilis muscle flap in repairing urethral perineal fistula after Miles operation. The clinical data of 3 patients with urethral perineal fistula treated in the Second Affiliated Hospital of Zhejiang University from September 2023 to November 2024 were analyzed retrospectively. All patients were male, aged from 59 to 68 years (mean 63 years). All patients underwent Miles operation because of low rectal cancer. Urethral perineal fistula occurred after 2 months to 13 years of the operation. The underlying comorbidities included diabetes (2/3), preoperative chemoradiotherapy (1/3), and chemotherapy alone (1/3). The endourethral fistula was located in the apical and membranous part of the prostate, with a diameter of 1.5-2.0 cm and a mean of 1.7 cm. Suprapubic cystostomy was performed one month before operation. In all 3 cases, perineal inverted "Y" incision was taken under general anesthesia to expose urethral fistula, cut off necrotic tissue and suture urethral fistula. The gracilis muscle of the right thigh was taken and turned through the perineal subcutaneous tunnel. and 6 stitches were suture at the urethral fistula. The operations of all 3 patients were completed successfully. The follow-up period ranged from 2 months to 12 months, with an average of 8 months. There was no case of urinary incontinence after removal of catheter 3 weeks after operation. In two patients, urethrography was reviewed 1 month after surgery to show no fistula residue and urethral stenosis, and the fistula was removed. In one patient with a history of radiotherapy, urethrography was reviewed 1 month after surgery to show a small amount of contrast overflow around the urethra, and urethrography was reviewed again 3 months after surgery to show no contrast overflow around the urethra. All the 3 patients had no disturbance of movement of the right lower limb, and the pain of different degrees of thigh incision was acceptable and basically relieved half a month after operation. Gracilis muscle flap is one of the effective methods for repairing urethral perineal fistula after Miles operation，which has a precise surgical result and few complications.

Floating needle therapy for the treatment of ureteral calculi: A case report.

An upper trunk brachial plexus injury patient underwent ulnar motor fascicular to biceps motor nerve transfer. At 6 months postoperative, the patient had trace biceps firing but was diagnosed with an unrecognized rupture of the distal biceps tendon, requiring reconstruction. Another patient with C5-T1 injury was noted to have distal biceps tendon rupture at the time of gracilis muscle transfer. Both patients had gravity-assisted elbow flexion at 1-year follow-up. Biceps rupture is an uncommon concomitant injury with brachial plexus trauma and challenging to diagnose in the context of a paretic limb. Thorough history and intraoperative biceps tendon palpation will ensure these injuries are identified.

Urethral injuries associated with pelvic fractures in female patients are a rare condition. The diagnosis and management of traumatic injury to the female urethra are not well-understood, as the literature on the subject is very limited. Hereby, the authors present a case of a 29-year-old female patient who presented with continuous incontinence. The patient had a history of trauma while riding a bicycle 18 years ago, resulting in a pelvic fracture, bladder rupture, and urethral rupture. She was managed with fracture fixation, bladder repair, and Suprapubic Catheter (SPC) insertion. Urethral repair was performed after six months, but the patient remained incontinent. Upon presentation to our hospital, the patient was diagnosed with vaginal stenosis and a large urethrovaginal fistula. She was managed with vaginoplasty followed by urethrovaginal fistula repair using gracilis muscle interposition. This procedure failed, resulting in the recurrence of the Urethrovaginal Fistula (UVF) and ongoing incontinence. The patient was re-operated, and fistula repair was accomplished using a local vaginal flap. This case highlights the complex nature of urethral injury in females, the challenges posed by delayed complications, and the necessity for multiple procedures.

Free gracilis muscle (GM) flaps represent a reliable workhorse procedure in the field of plastic and trauma surgery. However, only a small number of studies have examined this large group of patients regarding the morbidity of flap harvest. The aim of this prospective study was therefore to objectively investigate the morbidity of free GM flaps.A control group (n = 100) without surgery was recruited to assess interindividual differences in strength and range of motion (ROM) in the hip and knee joint (dominant vs. nondominant side). Additionally, for 50 patients with free GM flap surgery, these parameters were assessed in an identical manner.The control group showed significant interindividual differences in strength for abduction and adduction in the hip joint when comparing the dominant to the nondominant side, but no significant differences in the ROM. GM flap harvest led to no significant differences in maximum force 20.3 (± 13.8) months after surgery in all parameters/movements that were assessed. However, the ROM for abduction in the ipsilateral hip joint was significantly reduced after surgery.The GM flap has a low donor site morbidity and should therefore be considered as a first-line option for microsurgical reconstructive procedures. Moreover, the low morbidity is not affected by preexisting differences in strength when comparing the dominant to the nondominant side.

Recto-urethral fistulas represent a rare and challenging condition, occurring either congenitally or due to various prostatic and pelvic interventions such as radical prostatectomy and radiation therapies. This condition often manifests with symptoms such as pneumaturia, fecaluria, and urinary tract infections. Despite its rarity, this condition presents significant clinical management challenges due to the lack of consensus on standardized treatment protocols, particularly in patients with a history of irradiation. This study aims to systematically review the available literature on the efficacy and safety of primary surgical repair of adult-acquired recto-urethral fistulas. We conducted a comprehensive bibliographic search of MEDLINE, Scopus, and Web of Science Core Collection databases in August 2024, following the PRISMA guidelines. A total of 10 studies, covering over 500 patients, were included in our review. The most common surgical approach used was the transperineal technique with gracilis muscle flap interposition. Findings indicate higher complication rates and diminished healing in irradiated patients compared to non-irradiated counterparts. Although transperineal approaches generally resulted in high success rates irradiated individuals frequently required additional surgeries or definitive urinary diversion. Further research is required to establish evidence-based guidelines for optimal management, particularly for complex cases involving radiation-induced recto-urethral fistulas.

Facial reanimation surgery using a free functional gracilis muscle transfer is the standard of care in long-standing facial paralysis. Surgical revision rates are high, with most directed toward flap debulking and improving contour. During the index surgery, the muscle can be thinned extensively to potentially avoid revisions, but there is concern for injuring the neurovascular pedicle or weakening contractility. The authors hypothesize that primary flap thinning is safe without compromising smile contractility.Patients undergoing dynamic smile reconstruction with free functional gracilis muscle transfer were retrospectively reviewed over an 8-year period. Functional morphometric outcomes were evaluated with the Emotrics facial expression recognition software. Time to innervation, secondary procedures, and complications were also recorded.In total, 34 facial reanimation procedures met the inclusion criteria. The average muscle flap weight after primary thinning was 17.0 ± 9.3 g (range 5-46 g). Smile excursion improved by 7.7 ± 5.5 mm in the unilateral and 5.7 ± 3.4 mm in the bilateral paralysis groups, with significant improvement from preoperative commissure (p = 0.001) and smile angle (p = 0.003) measurements. One patient required a secondary debulking procedure. Secondary outcomes of improved reinnervation time and smile excursion weakly trended with decreased gracilis weight but did not achieve statistical significance. Complications included one flap loss, one donor site hematoma, one facial abscess, and one facial hematoma.Flap thinning at the time of primary free functional gracilis transfer did not result in increased complications or compromise its ability to produce symmetric smiles of adequate excursion. Compared to published cohorts, this technique may reduce the need for secondary revisions.

Background:Facial nerve palsy has severe morbidity, stemming from the loss of facial animation. Earlier attempts to restore eyelid function relied on static procedures. With the advancement in microsurgery techniques in recent years, dynamic eyelid reconstruction has gained more popularity. The goal is to maximize functional and aesthetic outcomes. This article aimed to highlight the current techniques and outcomes of dynamic eyelid reanimation.Methods:MEDLINE, PubMed, PubMed Central, and Cochrane databases were searched. The included articles were reviewed. The techniques, methods of assessment, and associated outcomes were extracted and compared.Results:Seventeen articles were included in the study. Tools used for assessment were diverse, including specific scales, questionnaires, and clinical examination. Techniques used were classified as nerve and muscle transfers. Nerve transfers included cross-facial nerve graft, nerve to masseter, and hypoglossal nerve transfer. Better results and lower morbidity were achieved with the combination of methods. Muscle transfers included free platysma muscle transfer as a free flap or graft, differentiated innervated gracilis muscle transfer, contralateral orbicularis oculi muscle, and temporalis muscle transfer. Better results were achieved with platysma-free functional muscle transfer.Conclusions:Dynamic reanimation has better results than static procedures, and a combination of dynamic and static procedures might have the best results. The chosen method must be individualized, with the choice mainly affected by denervation time and the age of the patient.