Vascularized innervated transfer of the clavicular head of the pectoralis major muscle in established facial paralysis.

Twenty cadaver dissections of the clavicular head of the pectoralis major muscle were carried out to determine the detailed anatomical arrangement of the vascular and nerve supply, with a view to using this muscle as an independent neuromyovascular unit in the treatment of established facial palsy. In all dissections, the muscle was found to have an independent nerve and vascular supply. A clinical case is reported with anatomical description and essential details of the operative technique. The ideal neuromyovascular unit is briefly described and the advantages of the pectoralis major for this use are illustrated. It is emphasized that limiting the goals of free muscle transfer to reanimation of the lower facial musculature will produce the most satisfactory results.