Comparison of one-stage free gracilis muscle flap with two-stage method in chronic facial palsy

 Abstract Background: Rehabilitation of facial paralysis is one of the greatest challenges faced by reconstructive surgeons today. The traditional method for treatment of patients with facial palsy is the two-stage free gracilis flap which has a long latency period of between the two stages of surgery. Methods: In this paper, we prospectively compared the results of the one-stage gracilis flap method with the two - stage technique. Results: Out of 41 patients with facial palsy refered to Hazrat-e-Fatemeh Hospital 31 were selected from whom 22 underwent two- stage and 9 one-stage method treatment. The two groups were identical according to age, sex, intensity of illness, duration, and chronicity of illness. Mean duration of follow up was 37 months. There was no significant relation between the two groups regarding the symmetry of face in repose, smiling, whistling and nasolabial folds. Frequency of complications was equal in both groups. The postoperative surgeons and patients' satisfaction were equal in both groups. There was no significant difference between the mean excursion of muscle flap in one-stage (9.8 mm) and two-stage groups (8.9 mm). The ratio of contraction of the affected side compared to the normal side was similar in both groups. The mean time of the initial contraction of the muscle flap in the one-stage group (5.5 months) had a significant difference (P=0.001) with the two-stage one (6.5 months). The study revealed a highly significant difference (P=0.0001) between the mean waiting period from the first operation to the beginning of muscle contraction in one-stage (5.5 months) and two-stage groups (17.1 months). Conclusion: It seems that the results and complication of the two methods are the same, but the one-stage method requires less time for facial reanimation, and is costeffective because it saves time and decreases hospitalization costs.