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Despite the wide spectrum of hemifacial microsomia manifestations, treatment mainly focuses on mandible and ear abnormalities, rather than on facial paralysis. In fact, the surgical treatment of facial paralysis associated with hemifacial microsomia is quite underdeveloped, because the degree of paralysis is frequently incomplete or partial. Timing and type of surgery are also difficult to determine. Neurovascular freemuscle transfer is now a standard procedure for the dynamic smile reconstruction of longstanding facial paralysis. This type of strategy has considerable potential in the treatment of facial paralysis in patients with hemifacial microsomia. We present here our experience with neurovascular freemuscle transfer for smile reconstruction in eight patients with facial paralysis associated with hemifacial microsomia. The age of the patients at the time of surgery ranged from 7 to 28 years old, average, 13.9 years. Six were male patients and two were female patients. The twostage method combining gracilis muscle transfer with crossface nerve grafting was performed in three patients, whereas the onestage transfer of the latissimus dorsi muscle was performed in five. To construct a natural or nearnatural smile, the muscles were transferred into the paralyzed cheek in all except one patient, in whom the latissimus dorsi muscle was transferred into the sublabial area to reconstruct a paralyzed lower lip. A dermal flap segment vascularized with perforating vessels from the latissimus dorsi muscle was simultaneously inserted into the underdeveloped cheek for softtissue augmentation in this patient. Muscle contraction was evident in all patients between 4 and 8 months after muscle transfer. Our present series revealed that neurovascular freemuscle transfer is a good option not only for smile reconstruction but also for restoration of the facial contours of patients with hemifacial microsomia. Compared with the twostage method combining gracilis muscle transfer with crossface nerve grafting, the onestage method using the latissimus dorsi muscle has some advantages, including a onestage operation, a shorter recovery period, and the absence of sequelae that occur after harvesting a sural nerve. Plast. Reconstr. Surg.109 1219, 2002.

A cross-leg free rectus abdominis flap, anastomosing to utilized “carrier” vessels of the contralateral noninjured leg, was used for reconstruction in six cases of extensive traumatic defects and deformities of a lower extremity. This method provides great advantages in free-flap reconstruction of complicated and unfavorable cases in which utilization of what would be suitable recipient vessels in the injured leg is most difficult, but there is good blood circulation of the leg.

Motor nerve conduction velocity in a sural nerve graft crossing the face for the treatment of facial paralysis was measured postoperatively for more than 3 years. Forty-three cases of free gracilis muscle transplantation combined with a cross-face nerve graft were evaluated. The cross-face nerve graft was stimulated at two sites more than 5 cm apart by bipolar stimulating electrodes, and conduction velocity was calculated by dividing the length of this segment by the difference between the latencies of the evoked action potentials recorded from the grafted muscle.

Patients afflicted with retinoblastoma or other malignant orbital tumors often undergo eyeball excision and irradiation in infancy, which results in severe deformities of the orbit. It is very difficult to achieve the reconstruction of such severely depressed and contracted eye sockets because both augmentation and formation of an eye socket are required. We usually perform a free-flap transfer with microvascular anastomoses in such situations and have experienced 25 cases since 1980. Various kinds of flaps, such as the groin flap, dorsalis pedis flap, scapular flap, and others, were utilized. The degree of depression and whether sufficient conjunctiva for lining of the eye socket remains are important in the selection and design of the donor flap. To obtain an orbit with a natural appearance, many of the patients required subsequent minor revision operations such as debulking, dermal fat grafts, canthoplasty, fascia suspension, and so on.

Microneurovascular free muscle transfer is fast becoming a standardized procedure in the treatment of established or longstanding facial paralysis. However, there is no general agreement as to whether muscle transfer should be employed for children who still are growing. A patient's natural growth may influence or disturb reproduction of a smile, or a child may not be able to collaborate with postoperative rehabilitation sufficiently well to obtain a satisfactory result. One may hesitate to employ the procedure for children aged under 10 out of fear of its technical difficulties. To investigate the influence of age, the results experienced by 23 patients under the age of 15 who underwent free muscle transfer combined with crossface nerve grafting were compared with those of adult patients. The treatment employed was a twostage operation consisting of crossface nerve grafting and subsequent free muscle transfer. Plast. Reconstr. Surg.101 1765, 1998.