Dynamic reconstruction of the paralyzed face, part II: Extensor digitorum brevis, serratus anterior, and anterolateral thigh

Rehabilitation of the paralyzed face requires consideration of the functional, esthetic, and psychological concerns of the afflicted patient. Lack of spontaneous facial animation significantly impairs the capacity to interact socially and convey emotion. With the advent of microneurovascular free tissue transfer, a new era of dynamic reconstruction was introduced, and symmetry with movement became a clinical reality. Although the gracilis is highly touted as the workhorse flap in facial reanimation surgery, a better understanding of flap physiology and neurovascular anatomy has contributed to the increased versatility in flap design while minimizing donor site morbidity. The purpose of this manuscript is to explore alternative donor muscle groups used in the surgical management of chronic facial paralysis and describe their operative technique, namely, the extensor digitorum brevis, serratus anterior, and anterolateral thigh flaps.