Background The aim of this study was to review the recipient vessels used in our cases of facial
reanimation with free functional muscle transfer and to identify patient variables
that may predict when the facial vessels are absent. From this we present a protocol
for vessel selection in cases when the facial artery and/or vein are absent.
Methods Patients were identified from November 2006 to October 2013. Data was collected
on patient demographics, facial palsy aetiology, history of previous facial surgery/trauma
and flap/recipient vessels used. A standard operative approach was adopted and performed
by a single surgeon.
Results Eighty-seven eligible patients were identified for inclusion amongst which 98 hemifaces
were operated upon. The facial artery and vein were the most commonly used recipient
vessels (90% and 83% of patients, respectively). Commonly used alternative vessels
were the transverse facial vein and superficial temporal artery. Those with congenital
facial palsy were significantly more likely to lack a suitable facial vein (P=0.03)
and those with a history of previous facial surgery or trauma were significantly more
likely to have an absent facial artery and vein (P<0.05).
Conclusions Our algorithm can help to guide vessel selection cases of facial reanimation with
free functional muscle transfer. Amongst patients with congenital facial palsy or
in those with a previous history of facial surgery or trauma, the facial vessels are
more likely to be absent and so the surgeon should then look towards the transverse
facial vein and superficial temporal artery as alternative recipient structures.
Keywords
Facial paralysis - Free tissue flaps - Microsurgery
