Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

Janik, Stefan; Marijić, Blažen; Faisal, Muhammad; Grasl, Stefan; Tzou, Chieh‐Han John; Rodriquez-Lorenzo, Andres; Seemann, Rudolf; Leonhard, Matthias; Erović, Boban M.

doi:10.1002/hed.27219

Head & Neck

2022

DOI: 10.1002/hed.27219

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Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

Stefan Janik

Blažen Marijić

Muhammad Faisal³

et al.

Abstract: It was the purpose of this study to evaluate the role of the serratus anterior free flap (SAFF) with its long thoracic nerve (LTN) as composite flap for dynamic facial reanimation. A total of 10 studies, published between 2004 and 2021, met inclusion criteria. Clinical data of 48 patients were used for the systematic review and analysis. One to three slips were used, mainly as one‐stage procedures (n = 39; 81.3%), to create different force vectors. Single or double innervated muscle transfers were utilized in … Show more

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Cited by 3 publications

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Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

Janik

Marijić

Faisal³

et al. 2022

Head & Neck

Self Cite

View full text Add to dashboard Cite

It was the purpose of this study to evaluate the role of the serratus anterior free flap (SAFF) with its long thoracic nerve (LTN) as composite flap for dynamic facial reanimation. A total of 10 studies, published between 2004 and 2021, met inclusion criteria. Clinical data of 48 patients were used for the systematic review and analysis. One to three slips were used, mainly as one‐stage procedures (n = 39; 81.3%), to create different force vectors. Single or double innervated muscle transfers were utilized in 32 (66.7%) and 16 (33.3%) cases with additionally harvested skin paddles in 4 (8.3%) patients. The LTN was mostly anastomosed to the ipsilateral masseteric nerve (45.8%; n = 22) or to remaining facial nerve branches (37.5%; n = 18), while cross‐facial‐nerve‐grafting was rarely used (16.7%; n = 8). The SAFF as composite flap with different force vectors proved to be a good candidate for immediate dynamic facial reanimation after any midface defects.

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Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

Janik

Marijić

Faisal³

et al. 2022

Head & Neck

Self Cite

View full text Add to dashboard Cite

show abstract

Muscle transposition and free muscle transfer in facial nerve reanimation

Jones,

Taylor,

AL Afif

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review This review highlights recent advances in facial reanimation surgery particularly related to muscle transposition and free functional muscle transfer (FFMT). Recent findings FFMT and muscle transposition are mainstays in the treatment of chronic facial paralysis. Recent literature evaluates single versus dual innervated FFMT, reanimation of the periocular region and lower lip depressors, and indications for such methods over gold standard FFMT techniques. New donor sites for muscle transposition and FFMT are also described. Summary Gracilis FFMT (GFMT) continues to be the gold standard in dynamic facial reanimation for patients with chronic facial paralysis. Muscle transposition should be considered in older patients, those medically unfit for long operative procedures, and individuals who prefer more immediate results. With respect to FFMT, described nerve coaptation patterns, surgical stages, and donor muscle choice vary. Standardization of data reporting and outcome measures is needed in future studies.

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Dynamic Repair Surgery for Late-Stage Facial Paralysis: Advances in Restoring Movement and Function

Sun,

Li,

Zhu

et al. 2024

JCM

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Purpose: Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function in late-stage facial paralysis, focusing on dynamic repair techniques involving nerve and muscle transplantation. Methods: The review encompasses studies on dynamic repair surgery for late facial paralysis, including techniques such as local muscle flap with pedicle transfer, vascularized nerve flap with pedicle transfer, and multiple muscle flap procedures. A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, covering studies from 2000 to 2024. Keywords included “dynamic repair”, “late-stage facial paralysis”, “nerve and muscle transplantation”, “muscle flap”, and “tendon transposition”. Included were clinical studies, systematic reviews, and meta-analyses reporting surgical outcomes. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. Results: Dynamic repair techniques involving nerve and muscle transplantation are essential for treating late-stage facial paralysis. Each surgical method has strengths and limitations. The masseter muscle flap demonstrates high success rates, although it can cause horizontal tension and jaw contour issues. The temporalis muscle flap is effective for smile restoration but may lead to temporal concavity. The gracilis muscle flap is widely used, especially with dual nerve innervation, showing high success in spontaneous smiles but requiring a longer recovery period. The latissimus dorsi flap is effective but can cause edema and shoulder issues. The serratus anterior free flap offers flexibility with precise vector positioning but may not achieve adequate lip elevation and can cause cheek swelling. Combined multi-flap surgeries provide more natural facial expressions but increase surgical complexity and require advanced microsurgical skills. Conclusions: Dual nerve innervation shows promise for restoring spontaneous smiles. One-stage surgery offers faster recovery and reduced financial burden. Comprehensive patient evaluation is crucial to select the most suitable surgical method. Dynamic repair techniques involving nerve and muscle transplantation provide effective solutions for restoring function and aesthetics in late-stage facial paralysis. Future research should focus on long-term outcomes, patient satisfaction, and standardizing surgical protocols to optimize treatment strategies.

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Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

Cited by 3 publications

References 52 publications

Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

Muscle transposition and free muscle transfer in facial nerve reanimation

Dynamic Repair Surgery for Late-Stage Facial Paralysis: Advances in Restoring Movement and Function

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