Dynamic Smile Reconstruction with the Extensor Brevis Digitorum Pedis Muscle Free Flap

On the basis of anatomic investigations, the extensor brevis digitorum pedis muscle free flap offer some advantages: adequate dimensions, minimal bulkiness which allows muscle division and insertion to the orbicularis oris muscle, a constant neurovascular pedicle with proper dimensions, a strong tendon which provides good anti–gravitational support and mimics muscular tonus, conferral of static symmetry and controlled contractions.

A two–stage procedure for cross–face reanimation of the paralyzed face with nerve graft was performed on 15 patients. The period required for initial voluntary movement of the transferred muscles ranged from 4 to 10 months after the second procedure. The period of postoperative follow–up ranged from 6 to 48 months. All the results were good, with symmetry both in static conditions and during controlled contractions.