One-Stage Gracilis Flap as a Procedure of Choice for Chronic Facial Palsy

Chronic facial palsy is a very annoying disease that affects patients and their families. The standard method of treatment is a two-stage free gracilis flap which has a long period of latency between the two stages of surgery. In this paper we compare the result of a one-stage gracilis flap with a two-stage technique. The total number of our patients was 31. Twenty-two patients were treated with the two-stage and 9 patients with the one-stage method. The two groups were matched according to age, sex, intensity of illness, duration, or chronicity of illness. Mean duration of follow-up was 37 months. There was no significant difference between the two groups regarding symmetry of the face in repose, smiling, or at rest, or in symmetry of the nasolabial folds. The frequency of complications was equal in the groups. Surgeon and patient satisfaction after surgery were equal in both groups. Mean excursion of muscle before and after surgery in both groups was 9.8 mm (one-stage group) and 8.9 mm (two-stage group), which was not significantly different. Mean time of beginning of contraction of muscle flap was 5.5 months in the one-stage group and 6.5 months in the two-stage group. The difference was significant (p = 0.001). Mean waiting time for patients from first seeking medical attention to the beginning of facial muscle contraction was 5.5 months in the one-stage group and 17.1 months in the two-stage group. This was clearly and highly significant (p = 0.0001). In conclusion, it seems that results and complications of the two methods are comparable, but the one-stage method has very early results, needs less time for facial reanimation, and is cost-effective. Therefore this technique should be considered “the procedure of choice” in treatment of chronic facial palsy.