Neurovascular Musculus Obliquus Internus Abdominis Flap Free Transfer for Facial Reanimation in a Single Stage

Abstract

A study of the anatomy and transplantation of the musculus obliquus internus abdominis with a neurovascular pedicle transfer for facial reanimation in one stage is presented. Eleven adult cadavers (22 face sides) were dissected to observe the shape, thickness, innervation, and blood supply of the musculus obliquus internus abdominis. The blood supply of this muscle primarily comes from the musculus obliquus internus abdominis branch of the deep circumflex iliac artery (diameter, 1.3 +/- 0.2 mm), but it can also come from the eleventh intercostal artery (diameter, 1.14 +/- 0.3 mm) and the infracostal artery (diameter, 1.5 +/- 0.2 mm). The branch of the deep circumflex iliac artery and its vena comitans, or the infracostal artery and its vena comitans, could be anastomosed for muscle transplantation. The innervation of the musculus obliquus internus abdominis comes from the tenth and eleventh intercostal nerves (length, 12.7 +/- 1.5 cm) and the infracostal nerve (length, 12.9 +/- 1.3 cm). The eleventh intercostal nerve and the infracostal nerve were selected for anastomosis of muscle transplantation. From November of 1995 to November of 1999, 14 patients with long established facial paralysis were treated with transplantation of a musculus obliquus internus abdominis flap in one stage and were followed for 10 months to 6 years. In 13 patients, the dynamic functions of the transplanted muscles were restored, the obliqueness of the mouth and philtrum while static was corrected, and the facial muscle activities while smiling were harmonized. The eyelids of the paralyzed side could be closed postoperatively, indicating that the function of the orbicularis oculi of the paralyzed side was restored. The single-stage transplantation of a free musculus obliquus internus abdominis flap with one vascular, multi-nerve pedicle is a new method for facial reanimation in the treatment of long established facial paralysis. Because of the simplicity of the procedure and the completeness of the functional reanimation of the paralyzed facial muscles, compared with the results of other free muscle flap transfers, it is an ideal procedure for facial reanimation.

Facial Reanimation Using Free Functional Muscle Transfer: Lessons Learnt From a Long Term Experience Comparing Innervation With Cross Facial Nerve Graft and Masseter Nerve

“…29 Microvascular free muscle transfer is the gold standard procedure for dynamic reanimation. Several muscles have been used including gracilis, 30 pectoralis minor, 31 latissimus dorsi, 32 rectus abdominis, 33 extensor digitorum brevis, 34 rectus femoris, 35 serratus anterior, 36 palmaris longus, 37 internal oblique, 38 and abductor hallucis. 39 Most commonly used muscle is the gracilis as its donor site complications are minimum and there is no functional deficit.…”

Muscle reinnervation in one or two stages?: experimental study in rats with end-to-side nerve graft

“…One end of the graft is sutured into a sectioned branch of the facial nerve on the healthy side. The other end is sutured to the nerve of the transplanted muscle, generally the gracilis muscle [1][2][3][4] , the pectoralis minor muscle 5,6 , or the latissimus dorsi muscle 7,8 , among others [9][10][11][12][13] .…”