Dual chimeric innervated vastus lateralis free flap for single stage blink and midface reanimation

Background: The immediate reconstruction of the face in the setting of radical parotidectomy for malignancy represents a particular challenge. We present a novel technique using 2 sections of the vastus lateralis muscle as a chimeric flap in combination with the anterolateral thigh (ALT) fasciocutaneous flap to achieve midface reanimation and eye closure after radical parotidectomy. Methods: The harvest technique in view of variations in chimeric muscle components, vascular pedicles, and neural coaptations is described herein. Results: On postoperative facial nerve examination, we observed encouraging results in middle-aged patients even in the context of radiotherapy. Conclusion: Although reanimation using the chimeric vastus lateralis free flap is yet to be objectively determined in a large series, our experience is that this flap adds the potential of dynamic midface movement and eye closure to our current reconstructive approach with excellent postoperative results in selected cases.