Dual chimeric innervated vastus lateralis free flap for single stage blink and midface reanimation.

Abstract

The immediate reconstruction of the face in the setting of radical parotidectomy for malignancy represents a particular challenge. We present a novel technique using 2 sections of the vastus lateralis muscle as a chimeric flap in combination with the anterolateral thigh (ALT) fasciocutaneous flap to achieve midface reanimation and eye closure after radical parotidectomy. The harvest technique in view of variations in chimeric muscle components, vascular pedicles, and neural coaptations is described herein. On postoperative facial nerve examination, we observed encouraging results in middle-aged patients even in the context of radiotherapy. Although reanimation using the chimeric vastus lateralis free flap is yet to be objectively determined in a large series, our experience is that this flap adds the potential of dynamic midface movement and eye closure to our current reconstructive approach with excellent postoperative results in selected cases.