FREE RECTUS FEMORIS MUSCLE TRANSFER FOR ONE-STAGE RECONSTRUCTION OF ESTABLISHED FACIAL PARALYSIS

The free vascularized rectus femoris muscle graft with a long motor ne rve was used for reconstruction of unilateral established facial paral ysis in one stage. The pedicle vessels were anastomosed to the recipie nt vessels in the ipsilateral face, and the motor nerve of the muscle, which was led through the upper lip, was sutured to the contralateral facial nerve. The advantages of this one-stage reconstruction as comp ared with surgery involving second-stage reconstruction are that the r econstruction can be completed in one stage and that the period requir ed for muscle refunctioning after sugery is short. The vascular supply of the rectus femoris muscle can emanate mainly from the later circum flex femoral artery. In our cadaveric study, five types of variation w ere found for origination of a nutrient artery of the muscle. The most common type was one in which the artery derived from the descending b ranch of the lateral circumflex femoral artery (39 percent). The motor nerve of the rectus femoris is derived from the femoral nerve under t he inguinal ligament and runs downward through the intermuscular space between the sartorius muscle and the iliopsoas muscle before entering the posteromedial part of the upper third of the rectus muscle. The a dvantages of using the rectus muscle are as follows: (1) safety and si mplicity exist with one main large arterial supply for arterial anasto mosis; (2) the length of the femoral nerve (more thant 20 cm) is adequ ate for reaching the contralateral facial nerve for suturing; (3) a si multaneous operation by two teams is possible with the patient in the supine position; (4) the force and distance of contraction are appropr iate to reanimate the face; (5) the rectus muscle can be separated as a segment with appropriate lengths; (6) the tendinous fascia in both e nds provides a reliable point for anchoring sutures, which provides fi rmer attachment; and (7) no loss of donor leg function occurs.