Microvascular Free Transfer of A Partial Gracilis Muscle to The Face



Microvascular Free Transfer of A Partial Gracilis Muscle to The Face


R. M. ZUKER





The use of a portion of the gracilis muscle is particularly well suited for facial reanimation. The desired length of muscle can be harvested with a percentage of muscle circumference as long as great care is taken to maintain the integrity of the pedicle (1, 2). Excess bulk can be avoided (3), and a reliable, innervated flap of the required dimensions can be obtained.




ANATOMY

The basic anatomy of the gracilis muscle is adequately described elsewhere in this volume (see Chapter 342). The muscle is identified and isolated, and the neurovascular pedicle is carefully dissected. The muscle remains on its vascular pedicle until it has been fully prepared and is ready for transfer, as described subsequently.


FLAP DESIGN AND DIMENSIONS

The required length of muscle then is assessed. The muscle will originate from the zygomatic arch and temporal fascia and will insert into preplaced sutures that have been sited carefully to replicate the activity on the normal side. Generally, four such sutures are used. One is into the lower lip, the second is into the modiolus, the third is into the more lateral portion of the upper lip, and the fourth is into the midportion of the upper lip. These four sutures are securely anchored; they will be used to maintain insertion of the muscle flap into place.

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Jun 26, 2016 | Posted by in General Surgery | Comments Off on Microvascular Free Transfer of A Partial Gracilis Muscle to The Face
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