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

The authors report the experience in facial reanimation using free innervat ed split and segmental latissimus dorsi muscle flap one-stage transfer in 8 6 patients with longstanding facial palsy. The segmental latissimus dorsi w as 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 fla p was made thinner by splitting the segmental muscle. The split segmental m uscle 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 th e 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-faci al nerve graft stage. From 1986 to October of 1997, 86 patients with longst anding facial paralysis were treated in our department. The duration of fac ial 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 o nly 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-mu scle neurolization. Study of 66 specimens of latissimus dorsi muscle in the cadavers is discussed.