Sue Gloria R, Ho Oscar H
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
Ann Plast Surg. 2019 May;82(5S Suppl 4):S310-S312. doi: 10.1097/SAP.0000000000001869.
Facial paralysis is a significant problem with functional, psychological, and esthetic consequences. Free muscle transfer for reanimation of the smile has been established as the preferred reconstructive method. However, little has been reported on the complications after this procedure. We sought to perform a critical analysis of these complications and their ultimate outcomes.
A retrospective review was performed on consecutive patients undergoing microsurgical reconstruction of the smile by the senior author from 2013 through 2017. Patient demographics including age, race, body mass index, and medical comorbidities were recorded. The cause of facial palsy and type of microsurgical reconstruction were assessed. Patient outcomes including complications and management of the complication were analyzed. All statistical analyses were performed using nonparametric analyses.
We identified 17 patients who underwent microsurgical reconstruction of the smile, with 1 patient undergoing bilateral procedures, for a total of 18 microsurgical smile reanimation procedures performed. Sixteen of these were 1-stage reconstructions with the coaptation of the nerve to the masseter, whereas 2 were 2-stage reconstructions using cross-facial nerve grafts. The gracilis muscle was used as the donor muscle in all cases. The patients had a median age of 26.5 and a median follow-up of 1.04 years from surgery. There were no major early complications observed in our cohort. Eight (44.4%) reanimations developed a minor complication that required subsequent reoperation. The reoperations were performed at a median of 0.97 years after the microsurgical procedure. The most common indication for reoperation was lateral retraction of the insertion of the transplanted muscle, which occurred in 5 (62.5%) patients. One patient underwent surgical exploration for an abrupt loss of transplanted muscle function after trauma to the cheek. Another patient had less than expected transplanted muscle activity at 1 year postoperatively and underwent exploration of the cross-facial nerve graft and a neurorrhaphy revision. Lastly, 1 patient developed significant rhytids over the transplanted muscle secondary to tethering of the skin to the underlying muscle. This patient underwent 2 subsequent revisions, with placement of acellular dermal matrix between the muscle and skin and fat grafting. All patients had functional animation of the transplanted muscle postoperatively.
Complications occurred in 44.4% of patients undergoing microsurgical reanimation of the smile. Most complications were minor in nature and were readily addressed with advancement of the transplanted muscle. All patients in our series had muscle function after the muscle transplantation.
面瘫是一个具有功能、心理和美学后果的重大问题。游离肌肉移植用于微笑重建已被确立为首选的重建方法。然而，关于该手术后并发症的报道较少。我们试图对这些并发症及其最终结果进行批判性分析。
对2013年至2017年由资深作者连续进行微笑显微外科重建的患者进行回顾性研究。记录患者的人口统计学信息，包括年龄、种族、体重指数和合并症。评估面瘫的原因和显微外科重建的类型。分析患者的结局，包括并发症及并发症的处理。所有统计分析均采用非参数分析。
我们确定了17例接受微笑显微外科重建的患者，其中1例接受双侧手术，共进行了18例微笑显微外科重建手术。其中16例为1期重建，将神经与咬肌吻合，2例为2期重建，采用跨面神经移植。所有病例均采用股薄肌作为供肌。患者的中位年龄为26.5岁，术后中位随访时间为1.04年。我们的队列中未观察到重大早期并发症。8例（44.4%）重建出现轻微并发症，需要后续再次手术。再次手术在显微外科手术后中位0.97年进行。再次手术最常见的指征是移植肌肉附着点的外侧回缩，5例（62.5%）患者出现这种情况。1例患者因脸颊外伤后移植肌肉功能突然丧失而接受手术探查。另1例患者术后1年移植肌肉活动低于预期，接受了跨面神经移植探查和神经吻合修复。最后，1例患者因皮肤与深层肌肉粘连，移植肌肉上方出现明显皱纹。该患者随后接受了2次修复，在肌肉和皮肤之间植入脱细胞真皮基质并进行脂肪移植。所有患者术后移植肌肉均有功能性活动。
接受微笑显微外科重建的患者中，44.4%发生了并发症。大多数并发症性质轻微，通过推进移植肌肉很容易解决。我们系列中的所有患者在肌肉移植后均有肌肉功能。
