{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:36:53Z","timestamp":1786988213890,"version":"build-2736575974"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Free functional gracilis transfer (FFGT) is the gold standard for dynamic facial reanimation in long\u2010standing facial paralysis and its success depends on the availability of reliable recipient vessels. In patients with compromised vessels due to prior surgery, radiation, or trauma, arteriovenous (AV) loops are a well\u2010established reconstructive strategy. However, their role in facial reanimation remains scarcely reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed all patients with facial paralysis receiving facial reanimation with FFGT at our center between January 2010 and March 2025. All patients with absent or compromised standard recipient vessels, who underwent facial reanimation using FFGT in combination with an AV loop, were included. A sequential approach with preoperative Doppler examination, intraoperative flow assessment, AV loop construction, and continuous Cook\u2010Schwartz Doppler monitoring was used before gracilis harvest. Each case was compared with an age\u2010matched cohort of patients who underwent conventional FFGT without AV loops to contextualize operative and ischemia times. Primary outcomes were technical success and perioperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 196 patients who underwent facial reanimation, four patients (4\/196, 2.0%) with compromised recipient vessels who received AV loop\u2010assisted FFGT were identified (mean age 57\u2009years (range: 40\u201365) years). The mean follow\u2010up time was 19.3\u2009months (13\u201330\u2009months). No AV\u2010loop thrombosis, flap loss, hematoma, wound complications, or donor\u2010site morbidity occurred. Compared with age\u2010matched controls, operative times were prolonged, whereas ischemia times remained comparable. Functional smile restoration was achieved in two of four patients within 12\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AV loop\u2010assisted FFGT is a technically feasible salvage approach for facial reanimation in patients with compromised recipient vessels, enabling restoration of vascular access and expanding reconstructive options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>FRKS (Freiburger Reister Klinischer Studien), No. FRK005908<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70238","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T07:40:37Z","timestamp":1778485237000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Arteriovenous Loop\u2010Assisted Free Functional Gracilis Transfer in Vessel\u2010Compromised Patients: A Salvage Strategy for Facial Reanimation"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9216-0807","authenticated-orcid":false,"given":"Justus","family":"Osterloh","sequence":"first","affiliation":[{"name":"Department of Plastic and Hand Surgery, Faculty of Medicine Medical Center\u2010University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1574-9589","authenticated-orcid":false,"given":"Jakob B. W.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Faculty of Medicine Medical Center\u2010University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Fricke","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Faculty of Medicine Medical Center\u2010University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3838-0543","authenticated-orcid":false,"given":"Cam Tu","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Faculty of Medicine Medical Center\u2010University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6668-7798","authenticated-orcid":false,"given":"Branislav","family":"Koll\u00e1r","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Faculty of Medicine Medical Center\u2010University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen U.","family":"Eisenhardt","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Faculty of Medicine Medical Center\u2010University of Freiburg  Freiburg 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