Technique evolution for facial paralysis reconstruction using functioning free muscle transplantation - Experience of Chang Gung Memorial Hospital

The author performed facial reanimation by using functioning free muscle transplantation in 116 cases from 1986 to 2000. Three consecutive five-year periods are presented in relation to each stage of the author's technical improvement. The first five years bulkiness and asymmetrical smiling with weak gum exposure were encountered and required correction. The second five years was a period of technical improvement, but with residual deformities. The third five-year period was one of technique refinement. The author extended the utility of the gracilis for different and more challenged problems, such as the use of a muscle plus skin two-unit composite flap connected by the septoperforator nutrients, not only for facial reanimation but also for intra-oral contracure release or extra-oral facial soft tissue and skin deficits replacement.