Arteriovenous Loop-Assisted Free Functional Gracilis Transfer in Vessel-Compromised Patients: A Salvage Strategy for...

Area of Science:

• Microsurgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Free functional gracilis transfer (FFGT) is standard for facial reanimation but requires reliable vessels.
• Compromised recipient vessels due to prior interventions necessitate alternative strategies.
• Arteriovenous (AV) loops are established for vascular reconstruction but underreported in facial reanimation.

Purpose of the Study:

• To evaluate the feasibility and outcomes of AV loop-assisted FFGT for facial reanimation in patients with compromised recipient vessels.
• To compare operative and ischemia times with conventional FFGT.

Main Methods:

• Retrospective analysis of patients undergoing FFGT for facial paralysis (Jan 2010 - Mar 2025).
• Inclusion of patients with compromised vessels who received AV loop-assisted FFGT.
• Preoperative Doppler, intraoperative flow assessment, AV loop construction, and postoperative monitoring.
• Comparison with age-matched controls undergoing conventional FFGT.

Main Results:

• Four patients (2.0%) with compromised vessels underwent AV loop-assisted FFGT.
• No AV loop thrombosis, flap loss, or major complications occurred.
• Operative times were longer, but ischemia times were comparable to controls.
• Functional smile restoration was achieved in 50% (2/4) of patients within 12 months.

Conclusions:

• AV loop-assisted FFGT is a technically feasible salvage procedure for facial reanimation.
• It successfully restores vascular access in patients with compromised recipient vessels.
• This technique broadens reconstructive possibilities for challenging cases.