Facial reanimation by one-stage microneurovascular free abductor hallucis muscle transplantation: Personal experience and long-term outcomes

Background: In 1990, Jiang Hua introduced a new method using one-stage reconstruction with free abductor hallucis muscle transfer for dynamic reanimation of established unilateral facial paralysis. The authors present their experience with this procedure and analyze the postoperative complications and long-term functional and aesthetic outcomes. Methods: From March of 1990 to March of 2010, 45 patients underwent the free abductor hallucis muscle transfer procedure in the authors' department. Forty-one were followed up for 54.6 months (range, 28 months to 17 years). The Toronto Facial Grading System and Facial Nerve Function Index were used to evaluate facial nerve function at 2 years after surgery and last follow-up. Complications and function of the donor foot were analyzed. Results: No postoperative mortality was found. Complications occurred in four of 41 patients, including muscle loss, infection, hematoma, and hypertrophic scar. The others obtained satisfactory symmetric faces in the static state and in voluntary contraction of the transferred muscles. Mean values for the Toronto Facial Grading System (50.6 ± 7.8) and the Facial Nerve Function Index (65.7 ± 11.4 percent) were significantly higher at 2 years postoperatively in comparison with preoperative status (21.2 ± 5.3 and 19.5 ± 3.6 percent, respectively) (p < 0.05). Long-term outcomes (Toronto Facial Grading System, 54.8 ± 6.9; Facial Nerve Function Index, 79.4 ± 9.6 percent) were awarded higher values than early outcomes shown at 2 years postoperatively (p < 0.05). Conclusions: Free abductor hallucis muscle transfer is safe and effective in dynamic reanimation of longstanding unilateral facial paralysis. Favorable long-term results demonstrate that the authors' technique is an alternative method for facial reanimation. Clinical Question/Level of Evidence: Therapeutic, IV.