Split thoracodorsal nerve funicular graft combined with functional latissimus dorsi musculocutaneous flap transfer for immediate facial reanimation after tumor ablation

The authors report a case of immediate facial reanimation resulting from functional latissimus dorsi musculocutaneous flap transfer and funicular grafting of the thoracodorsal nerve after cheek tumor ablation. After wide excision of the tumor, including the facial nerve except the temporal branch and part of the zygomatic major muscle and masseter muscle, the authors reconstructed the cheek skin and provided movement by performing a small-segment latissimus dorsi musculocutaneous flap transfer using Harii's method and the defect of the buccal and marginal mandibular branches of the facial nerve by funicular grafting from one of the two funicles of the thoracodorsal nerve. After 6 months, the transplanted, small-segment latissimus dorsi muscle showed good voluntary movement, and the lower orbiculus oris and depressor oris presented good functional recovery. The authors believe the two funicles of the thoracodorsal nerve can be used independently for two purposes: one for functional segmental muscle transfer and the other for nerve grafting to defects of branches of the facial nerve. This concept makes it possible to reconstruct multiple facial movements while minimizing donor site morbidity by means of immediate facial reanimation.