IN THE JULY SURGERY SPOTLIGHT, Greg Borschel, MD, and Ronald Zuker, MD, perform a Segmental Gracilis Muscle Transplant on a 15-year-old boy who has right unilateral acquired facial palsy due to a brain tumor. In preparation for this surgery, the boy has previously had a cross-face sural nerve graft placed.
In this eight-hour case, two teams work simultaneously. One team harvests and prepares the segment of the gracilis muscle, while the second team works at the recipient site, preparing the facial artery and vein for anastomosis, and preparing the previously placed cross-face sural nerve graft for coaptation from the motor nerve to the gracilis muscle.
At the donor site, Dr. Borschel explains the importance and the process of de-bulking and splitting the gracilis muscle and presents a detailed diagram that demonstrates how the graft will be modeled and placed. At the recipient site, Dr. Zuker demonstrates the movement of the facial muscles in creating a smile before measuring the anatomy inside the face so that the gracilis graft can be appropriately sized. He then prepares the distal stump of the previously placed sural nerve graft for connection to the new graft.
Dr. Borschel notes that while different teams utilize running sutures and GI staplers to anchor the gracilis transfer, his team’s approach is to use reinforcing mattress sutures and anchoring sutures in an figure 8 pattern in order to create a secure fixation at the level of the oral commissure. After blood supply to the flap is established, Drs. Borschel and Zuker anchor the graft at the commissure, fan out the muscle to achieve an appropriate level of tension, and the distal end is then sutured in place before closure.
- Watch Drs. Borschel and Zucker perform the segmental gracilis muscle transplant for free on PSEN.
- To view this surgery and earn up to 1.0 AMA PRA Category 1 Credit™, purchase the Surgery Spotlight: Segmental Gracilis Transfer to the Face online course.
Past Surgery Spotlight programs remain freely available to view on PSEN. Hard copies of these programs can also be purchased from the PSEN DVD Library. Surgery Spotlight is a video-based product line produced by the Plastic Surgery Education Network (PSEN).