Facial Reanimation of the Eye Using Neurovascularised Flap of Platysma

Abstract

Background: Dynamic reanimation is usually required to restore blink function in patients with chronic facial paralysis. In which case, platysma myocutaneous flap (PMF) is a good choice compared to gracilis flap. Platysma is a thin, pliable flap with matching skin colour to the eyelids. Despite this, it is underused. Aim: To investigate the neurovasculature of platysma in order to find a common “window” containing nerves and blood vessels supply which is present in every individual. This will aid the plastic surgeons to reconstruct the neurovasculature of the flap for grafting onto the eyelids. Methods: 3 fresh cadaver necks were dissected from 1 males and 2 females, aged 75-88 years old; (n=6 platysmas). 43 squared specimens (measuring 1.5cm x 1.5cm) surrounding any potential neurovascular structures were cut out, processed and analysed under high power microscope to confirm the presence of nerves and blood vessels. We also reviewed literature dated from 1999 to 2011. Results: From the literature reviewed, the authors concluded that PMF provided excellent functional and aesthetic outcome. In this study, we discovered a “window” flap (ranging from "2.5cm x 3cm‟ to "8cm x 10cm‟) bilaterally on each cadaver. This window is supplied by submental branch of facial artery, drained by facial vein, anterior and external jugular veins, and extensively innervated by cervical branch of facial nerve. Conclusion: We strongly advocate the use of PMF “window” by plastic surgeons in dynamic eyelids reanimation.