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J Plast Surg Hand Surg. 2015 Jun;49(3):183-8. doi: 10.3109/2000656X.2014.988218. Epub 2014 Dec 3.

Double innervated free functional muscle transfer for facial reanimation.

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Division of Plastic and Reconstructive Surgery, Hospital General Dr. Manuel Gea Gonzalez , Mexico City , Mexico.



The treatment of long-standing facial palsy represents a challenge for the reconstructive surgeon. Treatment is based on dynamic procedures such as functional muscle flaps. The benefit of added axonal load has recently been reported. This study describes a two stage technique involving dual innervation of a gracilis muscle flap with initial cross-facial nerve graft (CFNG) followed by free muscle transfer co-apted to both the CFNG and a masseter nerve for facial reanimation.


A total of nine patients from August 2008-July 2011 were operated on with the double innervated gracilis muscle flap. Pre- and postoperative electromyography was documented, and video analysis with the five-stage classification of reanimation outcomes was performed.


All patients recovered voluntary and spontaneous smile abilities, with an average of 70% motor unit recruitment. Based on the Terzis reanimation outcome classification, four patients had an excellent result, four good, and one moderate.


The double innervated gracilis muscle flap is a viable technique for the treatment of long-standing facial palsy. It enables a fast recovery with fast muscle activity, and allows an emotional smile and aesthetic symmetry.


Facial palsy; babysitter; facial reanimation; gracilis muscle flap

[Indexed for MEDLINE]

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