The conjoint medial circumflex femoral perforator and gracilis muscle free flap: anatomical study and clinical use for complex facial paralysis reconstruction.

摘要

BACKGROUN:: The aim of this study was to establish the anatomic basis of the conjoint medial circumflex femoral perforator and gracilis muscle flap and to expand the use of this flap in complex facial paralysis reconstruction. METHODS: An anatomic study was initially undertaken to record the existence, consistency, and diameter of musculocutaneous perforators emanating from the proximal third of the gracilis muscle to provide blood supply to the overlying fascia, subcutaneous fat, and skin. In a total of 20 clinical cases of gracilis muscle harvesting, the aforementioned anatomical data were recorded during flap dissection. At least one musculocutaneus perforator, consisting of one artery and two accompanying veins (vein caliber > 0.3 mm) was found in 95 percent of cases. RESULTS: The anatomical study was followed by successful use of the conjoint flap for reconstruction of longstanding facial palsy accompanied by a soft-tissue defect of the cheek. In the first stage, cross-face nerve grafting was performed. In the second stage, free transfer of the conjoint flap, consisting of the proximal third of the gracilis muscle and the overlying subcutaneous fat, was performed to the face. The only connection between the two components of the conjoint flap was one musculocutaneous perforator. When the flap was inset, the muscle was used for facial reanimation and partial obliteration of the soft-tissue defect, while the subcutaneous fat was used to obliterate the rest of the defect. CONCLUSION: The proposed technique ensured symmetry of the face, on both rest and animation, and obliteration of the cheek deformity.