Free split and segmental latissimus dorsi muscle transfer in one stage for facial reanimation

The authors report the experience in facial reanimation using free innervated split and segmental latissimus dorsi muscle flap one-stage transfer in 86 patients with longstanding facial palsy. The segmental latissimus dorsi was taken from the distal part of the muscle so that the muscle flap had an ultra-long neurovascular pedicle of 13 to 17.5 cm in length. The muscle flap was made thinner by splitting the segmental muscle. The split segmental muscle flap was transferred to the paralyzed side of the face with its ultra-long neurovascular pedicle passing through a tunnel in the upper lip to the normal side of the face. The neurovascular pedicle of the muscle flap was anastomosed with the facial nerve, artery, and veins, respectively, on the normal side of the face. The operation was designed without the cross-facial nerve graft stage. From 1986 to October of 1997, 86 patients with long-standing facial paralysis were treated in our department. The duration of facial palsy in this series ranged from 1.5 to 51 years. A satisfactory result was obtained in 80 cases, evaluated at 8 months to 2 years postoperatively. The expression movement of the soft tissues of the face can be seen not only over transferred muscle but also on the paralyzed muscle covered by the splitting muscle flap. It is supposed that this is the result of muscle-muscle neurolization. Study of 66 specimens of latissimus dorsi muscle in the cadavers is discussed.