Updates in Free Muscle Transfers for Smile Reanimation

Facial Plast Surg Clin North Am. 2025 Feb;33(1):95-107. doi: 10.1016/j.fsc.2024.07.012. Epub 2024 Sep 17.

Abstract

Facial paralysis severely impacts a person's ability to interact with the world. Advances in microsurgery, especially free neurotized muscle transfers, have greatly improved reanimation outcomes. The gracilis free muscle transfer, introduced in 1971, is the most widely used procedure for long-standing flaccid paralysis. This review covers recent innovations in gracilis reanimation, including vector design and neurotization options, and introduces the free strap muscle for dynamic facial reanimation.

Keywords: Facial paralysis; Facial reanimation; Free muscle transfer; Gracilis free flap; Nerve graft.

Publication types

  • Review

MeSH terms

  • Facial Paralysis* / surgery
  • Free Tissue Flaps / transplantation
  • Gracilis Muscle* / transplantation
  • Humans
  • Microsurgery / methods
  • Nerve Transfer* / methods
  • Plastic Surgery Procedures / methods
  • Smiling*