CC BY-NC-ND 4.0 · Indian J Plast Surg 2020; 53(01): 105-111
DOI: 10.1055/s-0040-1708587
Ideas and Innovations
Association of Plastic Surgeons of India

Use of the Facial Artery for Free Functioning Muscle Transfers: An Alternative Pedicle for Salvage in Brachial Plexus Lesions with Vascular Injuries

Anil Bhatia
1  Department of Brachial Plexus Surgery, Deenanath Mangeshkar Hospital, Kothrud, Pune, India
Kaustubh Prabhune
2  Department of Plastic Surgery, Deenanath Mangeshkar Hospital, Kothrud, Pune, India
Alex De Carvalho
3  Department of Plastic Surgery, Hospital of the Federal University of Sergipe, Sergipe, Brazil
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Publication Date:
06 April 2020 (online)



Free functional muscle transfer (FFMT) is a salvage procedure recommended in cases of brachial plexus injury with late presentations or failures of primary nerve reconstruction. The workhorse for most authors is the gracilis, and the most common indication is the restoration of elbow flexion. For successful revascularization of the muscle, donor vessels must be in proximity of the site of the muscle fixation and allow direct coaptation to a donor nerve, ideally without the use of nerve grafts. A major problem occurs when patients have sustained concomitant vascular injuries to the subclavian and/or axillary arteries and had previous surgical dissections in the area where the most common vascular pedicles are located. The authors report the use of the rerouted facial vessels as donors in these complex cases. The surgical technique is presented, along with three cases where the procedure was used. The flaps survived in all the patients and grade > 3/5 muscle contraction was observed in the two patients who had adequate follow-up. Conclusion: the use of the facial vessels as donor vessels is an option to revascularize a FFMT in the setting of severe vascular injury to the subclavian and axillary arteries.