Facial Reanimation With Free Latissumus Dorsi Muscle Transfer, a Comparative Study Between Lateral and Supine Approach

Abstract

In this article, the authors present the versatility of the Latissmus dorsi muscle as a donor option in facial reanimation and compare between different approaches in harvesting this muscle.The study included 24 Latissimus Dorsi (LD) functional muscles were transferred for smile reanimation of complete facial palsy. The patients were classified into 2 groups in which the muscle either harvested with supine or lateral (trans-axillary) approach. Muscle harvesting time, total operating times, blood loss, and bulkiness of the flap were analyzed and compared. The hypoglossal nerve was used in 14 cases, the masseteric nerve in 4 cases, and the lower trunk of the facial nerve was used in 6 cases as adonor nerve. No microvascular complications were observed, hematoma occurred in 2 cases only. No donor site complications in any of the cases.The trans-axillary approach provides less operative time, blood loss, and donor site morbidity, while the classic approach is easier and has the advantage of skin paddle in complex cases.

Down with the Bean Bag: A Multi-institutional Experience with Total Latissimus Muscle Free Flap Harvest in the Supine Position

“…Several authors have reported partial anterior border muscle-sparing flap harvest from the supine position as the optimal approach. [6][7][8][9] We extend this indication and report safe and efficient harvest of the entire muscle for a wide range of indications in three teaching institutions. The exposure for pedicle dissection, ease of anterior border delineation from the serratus, and gravity-assisted countertraction when performing the superficial and deep muscle dissection is preferable to the lateral position in the author's collective experience.…”

“…The authors report our experience and preference for the harvest of the latissimus muscle from the supine position. Supine harvest of the TDAP and muscle-sparing anterior border latissimus flaps has been described in prior work [6][7][8][9][10] ; however, supine harvest of the total muscle has not been described. We report our multiinstitutional experience with supine full muscle harvest.…”