Ten Years’ Follow-Up after Microsurgical Reconstruction of the Lip Using Forearm Flap Combined with Gracilis Muscle Transfer

The purpose of this research to address objective excursion and symmetry results from a series of free gracilis muscle transfer (FGMT) cases and examine the predictive intraoperative number of vectors anchored during flap inset on outcomes. A retrospective analysis performs by data retrieved from the HUSM Plastic & Reconstructive Surgery OR Registry from January 2005 to June 2019. All patients who reported facial nerve palsy were recorded and re-evaluated. All characteristics in interest were epidemiologically tabulated and analyzed in detail. Subsequently, outcome assessment was performed to look for facial symmetry and smile excursion compared to the healthy side of the face—this study exempted by the Institutional Review Board of the Hospital of University of Sciences Malaysia. Out of 12 patients diagnosed with facial palsy, four patients underwent static facial reanimation. Eight patients underwent a dynamic facial reanimation, with 4 of them completed two stages of cross-facial nerve grafting (CFNG) and free gracilis muscle transfer (FGMT). One of the FGMTs patients had missed a follow-up. The mean age was 20 (range 11 to 30), one patient was male, and two were female. The mean duration for follow-up was 69 months. The mean duration of operating time was 8.67 hours. All operations without complication, and there was no microvascular re-exploration. Smile excursion and angle excursion at smile improved following FGMT. Association between the number of vectors anchored during flap inset to the outcome were identified. Dynamic facial reanimation using FGMT still the gold standard of treatment, which provides an excellent quantifiable improvement in oral commissure excursion and facial symmetry with smiling. The use of multivector gracilis flap was suggestive to associate with the good outcome on excursion and symmetrical of the smile.

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Outcomes after rotational infraspinatus muscle transfer for irreparable massive rotator cuff tears and long-term follow-up

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2021.01.011 ◽

2021 ◽

Vol 30 (4) ◽

pp. e183-e184

Author(s):

Hideki Asato

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tears ◽

Muscle Transfer ◽

Massive Rotator Cuff Tears ◽

Infraspinatus Muscle ◽

Long Term Follow Up

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Facial Reanimation of Patients With Neurofibromatosis Type 2

Operative Neurosurgery ◽

10.1227/neu.0b013e31823a819f ◽

2011 ◽

Vol 70 (suppl_2) ◽

pp. ons237-ons243 ◽

Cited By ~ 2

Author(s):

Kalpesh T. Vakharia ◽

Doug Henstrom ◽

Scott R. Plotkin ◽

Mack Cheney ◽

Tessa A. Hadlock

Keyword(s):

Facial Paralysis ◽

Neurofibromatosis Type ◽

Neurofibromatosis Type 2 ◽

Gracilis Muscle ◽

Single Stage ◽

Care Plan ◽

Muscle Transfer ◽

Facial Reanimation ◽

Oral Commissure

ABSTRACT BACKGROUND: Neurofibromatosis type 2 (NF2) is a tumor suppressor syndrome defined by bilateral vestibular schwannomas. Facial paralysis, from either tumor growth or surgical intervention, is a devastating complication of this disorder and can contribute to disfigurement and corneal keratopathy. Historically, physicians have not attempted to treat facial paralysis in these patients. OBJECTIVE: To review our clinical experience with free gracilis muscle transfer for the purpose of facial reanimation in patients with NF2. METHODS: Five patients with NF2 and complete unilateral facial paralysis were referred to the facial nerve center at our institution. Charts and operative reports were reviewed; treatment details and functional outcomes are reported. RESULTS: Patients were treated between 2006 and 2009. Three patients were men and 2 were women. The age of presentation of debilitating facial paralysis ranged from 12 to 50 years. All patients were treated with a single-stage free gracilis muscle transfer for smile reanimation. Each obturator nerve of the gracilis was coapted to the masseteric branch of the trigeminal nerve. Measurement of oral commissure excursions at rest and with smile preoperatively and postoperatively revealed an improved and nearly symmetric smile in all cases. CONCLUSION: Management of facial paralysis is oftentimes overlooked when defining a care plan for NF2 patients who typically have multiple brain and spine tumors. The paralyzed smile may be treated successfully with single-stage free gracilis muscle transfer in the motivated patient.

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Does technical components of microanastomoses influence the functional outcome of free gracilis muscle transfer for elbow flexion in traumatic brachial plexus injury?

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2021.102827 ◽

2021 ◽

pp. 102827

Author(s):

Francisco Vilmar Felix Martins-Filho ◽

Fernanda do Carmo Iwase ◽

Gustavo Bersani Silva ◽

Alvaro Baik Cho ◽

Teng Hsiang Wei ◽

...

Keyword(s):

Brachial Plexus ◽

Functional Outcome ◽

Brachial Plexus Injury ◽

Elbow Flexion ◽

Gracilis Muscle ◽

Muscle Transfer

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PROXIMAL ULNAR STUMP STABILITY AFTER USING THE PRONATOR QUADRATUS MUSCLE TRANSFER COMBINED WITH THE SUAVÉ-KAPANDJI PROCEDURE IN RHEUMATOID WRIST

Hand Surgery ◽

10.1142/s0218810414500051 ◽

2014 ◽

Vol 19 (01) ◽

pp. 25-32 ◽

Cited By ~ 2

Author(s):

Chairoj Uerpairojkit ◽

Somsak Leechavengvongs ◽

Kanchai Malungpaishorpe ◽

Kiat Witoonchart ◽

Panai Buddhavibul

Keyword(s):

Sagittal Plane ◽

Distal Radioulnar Joint ◽

Muscle Transfer ◽

Pronator Quadratus ◽

Radioulnar Joint ◽

Rheumatoid Wrist ◽

Joint Disorder ◽

The Mean ◽

Pronator Quadratus Muscle

The pronator quadratus muscle transfer combined with the Sauvé-Kapandji procedure was used to treat the distal radioulnar joint disorder in ten rheumatoid wrists for prevention against instability of the proximal ulnar stump. All patients were female with a mean age of 46.6 years. The mean follow-up time was 24.2 months. Postoperatively, supination increased in all patients with a mean of 50 degrees. Pain decreased significantly and none complained of prominence of the proximal ulnar stump in normal pronated position and during a tight grip. The wrist radiographs of both coronal and sagittal planes in normal and stress fisting views were used to evaluate the postoperative static and physiologic loaded stability of the proximal ulnar stump. It had shown this procedure provided good static proximal ulnar stump stability in both coronal and sagittal planes. However, in physiologic loaded condition, it was able to provide stability only in the sagittal plane.

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Free Flap Reconstruction of Traumatic Pediatric Foot and Ankle Defects: An Analysis of Clinical and Functional Outcomes

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1727187 ◽

2021 ◽

Author(s):

Rajiv P. Parikh ◽

Austin Ha ◽

Thomas Tung

Keyword(s):

Limb Salvage ◽

Functional Outcomes ◽

Free Flaps ◽

Ankle Injuries ◽

Foot And Ankle ◽

Fasciocutaneous Flaps ◽

Muscle Flaps ◽

Microsurgical Reconstruction ◽

Pediatric Foot

Abstract Background Traumatic lower extremity injuries involving the foot and ankle can have devastating consequences and represent a complex reconstructive challenge. To date, there are limited reports on microsurgical reconstruction for foot and ankle defects in children. This study aims to evaluate clinical and functional outcomes of free flaps for pediatric foot and ankle injuries. Methods This is a retrospective review of patients undergoing free flaps for traumatic foot and ankle defects at a pediatric trauma center between 2000 and 2015. Patients with less than 5-year follow-up were excluded. Demographics, clinical characteristics, and postoperative outcomes were evaluated. Results Thirty patients undergoing 30 flaps were analyzed. The mean age was 11.9 years (range: 2 to 17 years). Muscle flaps (n = 21, 70%) were more common than fasciocutaneous flaps (n = 9, 30%). Limb salvage with functional ambulation was achieved in 96.7% of patients (n = 29). The complication rate was 33.3% (n = 10), with wound breakdown (n = 6, 20.0%) as most common feature. There were no significant differences in limb salvage, total or partial flap loss, fracture union, and donor-site complications based on flap type. Fasciocutaneous flaps were more likely to require revision procedures for contour compared with muscle flaps (55.6 vs. 9.5%, p = 0.013). Mean follow-up was 8.5 years. Conclusion Microsurgical reconstruction of pediatric foot and ankle defects results in high rates of limb salvage. A defect- and patient-centered approach to reconstruction, emphasizing durable coverage and contour, is critical to facilitating ambulation and ensuring favorable long-term functional outcomes.

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