Supplementary Material for: A Possible Expanded Timeline for Salvage Facial Reanimation Surgery: A Case Report

Background: Successful salvage facial reanimation procedures involving transfer of nerve to masseter (NTM) to an existing gracilis free muscle transfer (GFMT) have been reported when performed within 6 months.
Methods: Medical records were reviewed for patients who had undergone a salvage or secondary facial reanimation surgery after an initial suboptimal GFMT by cross face nerve face graft (CFNG).
Results: Between 2019-2024, three patients underwent salvage or secondary facial reanimation surgery after an initial procedure failed to produce movement by 11, 17 and 14 months respectively. Intraoperatively, the existing gracilis of patients 1 and 3 stimulated at 2mA and so a salvage procedure involving NTM transfer to the obturator nerve of the existing GFMT was performed. Successful smile was noted at 5 months for patient 1 and no facial movement after 12 months for patient 3. For patient 2, a secondary facial reanimation surgery (GFMT from the contralateral leg with innervation by the NTM) was performed due to lack of existing gracilis electrical stimulation and produced a successful smile noted at 7 months.
Conclusions: This study demonstrates that successful salvage of a failed GFMT by CFNG is possible through transfer of the NTM to the obturator nerve even after 11 months.

背景：已有研究报道，若在初次经跨面神经移植辅助的股薄肌游离肌移植术（gracilis free muscle transfer, GFMT）后6个月内，实施神经至咬肌移植术（nerve to masseter, NTM）修复，可获得成功的挽救性面部动力重建效果。
方法：回顾性分析2019年至2024年的临床病历资料，纳入对象为初次经跨面神经移植（cross face nerve face graft, CFNG）辅助的股薄肌游离肌移植术效果不佳，随后接受挽救性或二次面部动力重建手术的患者。
结果：2019至2024年间，共有3例患者因初次手术分别于术后11、17、14个月未出现面部肌肉活动，接受了挽救性或二次面部动力重建手术。术中检测显示，患者1与患者3的现存股薄肌对2mA电流刺激有反应，遂实施挽救性手术，将神经至咬肌移植术连接至现存股薄肌游离肌移植术的闭孔神经。患者1于术后5个月可观测到成功的微笑动作，而患者3在术后12个月仍未出现面部肌肉活动。患者2因现存股薄肌无电刺激反应，接受了二次面部动力重建手术：取自对侧腿部的股薄肌游离肌移植，并通过神经至咬肌移植术进行神经支配，该患者于术后7个月成功出现微笑动作。
结论：本研究证实，即便初次手术失败已超过11个月，通过将神经至咬肌移植术连接至现存股薄肌游离肌移植术的闭孔神经，仍可成功挽救经跨面神经移植辅助后失败的股薄肌游离肌移植术。