Tri-Vector Gracilis Microneurovascular Free Tissue Transfer with Periocular Component to Achieve a Duchenne Smile in Patients with Facial Paralysis

Importance: Traditional techniques of facial reanimation using gracilis free tissue transfer do not address the lower eyelid or provide contraction at the site of orbicularis oculi, which is necessary to create a natural appearing Duchenne smile. In this report, we describe a novel technique to achieve this element of a true mimetic smile using a tri-vector gracilis muscle flap. Objective: To describe a novel gracilis free flap technique for facial reanimation to provide contraction of the inferior and lateral orbicularis oculi and achieve a Duchenne smile. Design, Setting, and Participants: This was a surgical pearls-description of a novel surgical technique at Academic Tertiary Medical Center. Three patients underwent the operation.