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 FIG. 18-33. Paralysis of right side of face.
 FIG. 18-34. Reanimation of the face was performed as in the method originally described by Harii, using the gracilis muscle.
 FIG. 18-35. The gracilis muscle was transplanted to the paralyzed side and the neurovascular repairs performed before insetting the muscle.
 FIG. 18-36. At rest, there is good symmetry of the facial appearance.
 FIG. 18-37. Spontaneous motion is restored by strong contraction of the gracilis muscle, in this case more strongly than on the contralateral unparalyzed side. Front view.
 FIG. 18-38. Side view, at rest.
 FIG. 18-39. Side view, smiling.
CASE 8
A 21-year-old woman avulsed her dominant hand in a roping injury.
 FIG. 18-40. X ray of the amputated hand.
 FIG. 18-41. The hand was successfully replanted, but the flexor and extensor muscles had been avulsed and destroyed.
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 FIG. 18-42. The gracilis muscle transplant was planned to provide proximal finger flexion.
 FIG. 18-43. The muscle is isolated (blue marker under pedicle).
 FIG. 18-44. Postoperative view with skin graft on muscle transplant.
 FIG. 18-45. Late follow-up shows improving hand function. Extension.
 FIG. 18-46. Flexion.
CASE 9
A 29-year-old man suffered a fracture dislocation of the elbow that led to severe Volkmann's contractures.
 FIG. 18-47. The extremity was not used, resulting in atrophy of all muscle groups.
 FIG. 18-48. Preliminary reconstruction was performed with pedicle transfer of the latissimus dorsi muscle across the elbow to provide elbow and wrist extension. Latissimus elevated ready for transfer to back of arm and dorsum of forearm.
 FIG. 18-49. Muscle transferred across elbow.
 FIG. 18-50. Distal muscle wrapped around "extensor wad."
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