Reconstructing facial contour deformities with vascularized flaps in facial reanimation surgery

Facial paralysis is often accompanied by contour deformity. Reconstruction of this complex facial paralysis presents a challenge to reconstructive surgeons. Simultaneous reconstruction of established facial paralysis and concomitant contour deformity may require two flap components: a functional muscle flap for dynamic smile reconstruction and a vascularized flap for restoration of contour deformity. Free vascularized tissue transfer has become a primary option for reconstruction of major facial contour deformity. Adipofascial flaps are especially favored due to strengths including versatility in flap design and manipulation and relatively low donor morbidity. A chimeric flap combining a functional muscle segment with vascularized adipofascial tissue can be an excellent option. To obtain spatial freedom of each flap component when insetting, the chimeric flap should have sufficient pedicle length. The medial thigh for a gracilis muscle-based chimeric flap or the back for a latissimus dorsi-based chimeric flap are popular donor sites. However, a secondary approach always needs to be prepared after the vascularized flap transfer to achieve optimal outcomes. Fat transfer and/or liposuction can be considered for second-touch procedure, which can be combined with revision for reanimation.