Recipient Vessel Utilization in Gracilis Free Functional Muscle Transfer for Facial Reanimation: A 12-Year Single-Center Experience
In brief
Alternative vessels served 1 in 5 gracilis transfers with similar flap outcomes
In this 151-patient, single-center review, surgeons used non-facial recipient vessels in 18.5% of gracilis muscle transfers, most often the superficial temporal system. Overall flap survival was 97.4%, and vessel groups did not differ significantly in complications, flap loss, or muscle activation, although surgical site infections were more frequent with alternative vessels. The findings support anatomy-guided options when facial vessels are unsuitable.
- Journal
- Microsurgery (Q1)
- Published
- 1 December 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Jose E Telich-Tarriba, Nicole Llamas-Ostos, Kenzo A Fukumoto-Inukai, Lino E Ramirez-Sosa, Osmani A Castillo-Garrido, Alexander Cardenas-Mejia
- PMID
- 42965300
- DOI
- 10.1002/micr.70321
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 2 November 2026): Gracilis free-muscle transfer, recipient vessels, complications and flap survival
Abstract
BACKGROUND: Free functional muscle transfer (FFMT) using the gracilis muscle is a well-established technique for smile restoration in long-standing facial paralysis. However, recipient vessel selection remains poorly standardized, particularly when facial vessels are unavailable. This study evaluated recipient vessel utilization, associated clinical outcomes, and potential predictors of alternative vessel selection to propose a practical surgical algorithm. METHODS: A retrospective review of patients undergoing gracilis FFMT for facial reanimation between 2011 and 2022 was performed. Demographic, clinical, and operative characteristics were compared between facial and non-facial recipient vessel groups using Fisher's exact test and Welch's t-test. Exploratory multivariable logistic regression analyses evaluated factors associated with alternative vessel utilization and complications. RESULTS: A total of 151 patients were included (mean age, 20.9 ± 18.6 years), predominantly with congenital facial paralysis (68.2.%). Facial vessels were used in 123 cases (81.5%), while alternative vessels were required in 28 (18.5%), most frequently the superficial temporal system. Vascular pedicle and gracilis muscle lengths were significantly longer in the non-facial vessel group, while ischemia time was shorter. Overall complications occurred in 27.8% of patients, with a flap survival rate of 97.4%. No significant differences were observed between recipient vessel groups in overall complications (26.0% vs. 35.7%; p = 0.351), flap loss, or inadequate muscle activation. Surgical site infections were more frequent in the non-facial vessel group (p = 0.023). Exploratory subgroup analyses identified younger age in patients experiencing complete flap loss (p = 0.017) or inadequate muscle activation (p = 0.010). CONCLUSIONS: Facial vessels remain the preferred recipients for gracilis FFMT, with the superficial temporal system providing a suitable alternative. Recipient vessel selection was not associated with significant differences in overall complications, flap survival, or muscle activation. A flexible, anatomy-guided algorithm may facilitate surgical planning when facial vessels are absent or unsuitable.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.