再神经化的股薄肌游离皮瓣是面部重建的主要方法。该手术通常在腮腺切除手术之后进行，适用于已进展到周围结构的晚期肿瘤。如果需要进行其他重建手术来修复缺陷，寻找供体血管可能会有问题。本文描述了一种在术后局限血管的病人中，通过口腔吻合来植入再神经化的股薄肌游离皮瓣的方法，以避免静脉中插移植物。一个52岁的男性患者患有深腮腺叶腺癌，接受了包括颞下颌角、颞下颌关节和面部软组织在内的根治性手术切除（缺损大小：8 cm × 4 cm）。第二次手术进行了双皮瓣重建，修复了颞下颌缺损并植入切断脸神经。第三次手术使用了长10 cm的再神经化股薄肌游离皮瓣完成了面部重建。股薄肌皮瓣的植入是倒置的，使得近端皮瓣（蒂侧）位于颊黏膜侧，从而实现了通过口腔吻合从对侧连接血管。手术过程中未发生并发症。然而，在股薄肌再神经化之前，腺癌出现了复发。患者还存在远处的脑和肺转移，并接受了最佳支持性治疗。倒置的股薄肌游离皮瓣可能是一种在血管耗竭的患者中获得面部重建的选择，可避免使用长时间的中插静脉移植物。 © 2023 Wiley Periodicals LLC.

The reinnervated gracilis muscle free flap represents a workhorse of facial reanimation. This procedure is carried out secondarily to parotid resections, due to advanced tumors that spread to the surrounding structures. Finding recipient vessels might be problematic if other reconstructive procedures are needed to address the defects. This paper describes a procedure to inset a reinnervated gracilis muscle free flap in a vessel depleted patient, through intraoral anastomoses to avoid venous interposition grafts. A 52-year-old man developed an advanced adenocarcinoma of the deep parotid lobe and underwent radical surgical excision including the mandibular ramus, condyle, and facial soft tissues (defect size: 8 cm × 4 cm). A secondary double-flap reconstruction restored the mandibular defect and inset a cross-face nerve graft. A third intervention finalized the facial reanimation with a 10 cm reinnervated gracilis muscle free flap. The gracilis flap inset was inverted resulting in the proximal flap (pedicle side) lying on the buccal aspect. This allowed vessel joining from the contralateral side via intraoral anastomoses. No complications occurred within and after the intervention. However, the adenocarcinoma relapsed before reinnervation of the gracilis. The patient also had distant brain and lung metastases and received best supportive care. The inverted gracilis muscle free flap may represent an option for attaining facial reanimation in vessel-depleted patients avoiding long interposition venous grafts.© 2023 Wiley Periodicals LLC.