Harii K, Asato H, Yoshimura K, Sugawara Y, Nakatsuka T, Ueda K
Department of Plastic and Reconstructive Surgery at the University of Tokyo Graduate School of Medicine, Japan.
Plast Reconstr Surg. 1998 Sep;102(4):941-51. doi: 10.1097/00006534-199809040-00001.
The two-stage method combining neurovascular free-muscle transfer with cross-face nerve grafting is now a widely accepted procedure for dynamic smile reconstruction in cases with long established unilateral facial paralysis. Although the results are promising, the two operations, about 1 year apart, exert an economic burden on the patients and require a lengthy period before obtaining results. Sequelae such as hypoesthesia, paresthesia, and conspicuous scar on the donor leg for harvesting a sural nerve graft also cannot be disregarded. To overcome such drawbacks of the two-stage method, we report a refined technique utilizing one-stage microvascular free transfer of the latissimus dorsi muscle. Its thoracodorsal nerve is crossed through the upper lip and sutured to the contralateral intact facial nerve branches. Reinnervation of the transferred muscle is established at a mean of 7 months postoperatively, which is faster than that of the two-stage method. In our present series with 24 patients, 21 patients (more than 87 percent) believed that their results were excellent or satisfactory, which also compares well with the results of the two-stage method combining free-muscle transfer with cross-face nerve graft.
将神经血管游离肌肉移植与跨面神经移植相结合的两阶段方法，现已成为长期单侧面瘫患者动态微笑重建的一种广泛接受的手术方法。尽管结果令人鼓舞，但这两个手术相隔约1年，给患者带来经济负担，且需要很长时间才能取得效果。取腓肠神经移植时供区腿部的感觉减退、感觉异常和明显瘢痕等后遗症也不容忽视。为克服两阶段方法的这些缺点，我们报告一种改良技术，即采用背阔肌的一期微血管游离移植。其胸背神经穿过上唇并缝合至对侧完整的面神经分支。移植肌肉的再支配在术后平均7个月时建立，比两阶段方法更快。在我们目前的24例患者系列中，21例患者（超过87%）认为其效果极佳或满意，这与游离肌肉移植与跨面神经移植相结合的两阶段方法的结果相比也很好。
