A gracilis free muscle transfer is intended to restore dynamic smile function in flaccid paralysis or synkinesis patients who are outside of the window or otherwise not ideal candidates for nerve transfers.
A small slip of muscle is taken from the inner thigh (the gracilis muscle) and transplanted into the face in the same orientation as the major smile muscles. In order for this muscle transplant to survive, it must be hooked up to an artery, vein, and a nerve in the face. To obtain movement of this muscle, the transplanted gracilis may be hooked up to a cross-facial nerve graft, the masseteric (chewing) nerve, or a small branch of functioning facial nerve. Each of these options have various pros and cons, and Dr. Yver will discuss these with you in detail at your consultation visit.
What to expect during gracilis free muscle transfer surgery?
This surgery is performed under general anesthesia in the operating room. On the day of surgery, you will have a chance to meet with Dr. Yver to ask any questions and sign the necessary paperwork. The surgery may last 6-8 hours, depending on the number of concurrent procedures being performed. Patients typically spend 1-2 nights in the hospital following a gracilis free muscle transfer, in order to monitor the health of the transplanted muscle. It is common for patients to be discharged with small surgical drains in the face and in the thigh that may be removed 3-5 days later in clinic. You will receive instructions on how to care for these drains before you leave the hospital. You will need somebody to drive you to and from the hospital.
What can I expect after surgery?
After surgery, you will be asked to keep your leg wrapped as much as possible for 2 weeks. After 72 hours, these dressing may be temporarily removed and you can shower as normal. You will be provided with antibiotic ointment to apply to the sutures. It is not uncommon to experience significant facial swelling or bruising for a month after surgery. Patients are encouraged to sleep with their head propped up on several pillows in order to minimize swelling. The stitches may take 10-14 days to fully dissolve. Patients are encouraged to avoid any exercise, heavy lifting, or strenuous physical activity for two weeks after surgery, or until they are cleared at their post-operative visit.
When will I see results?
Results are not seen immediately after surgery, as it takes time for the nerves to grow into the transplanted muscle. Final results may be seen between 3 months – 1 year following gracilis free muscle transfer, depending on the source of nerve input.