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.
Keywords
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