Reconstruction of the aesthetic units of the face with microsurgery: Experience in five years

Esthetic Restoration in Progressive Hemifacial Atrophy (Romberg Disease)

“…[1][2][3][4][5][6][7][8] Free Microsurgical Transfer to Volume Restoration Thirty-nine articles were included in this second group and were published from 1974 to 2011. 12,21,25,26,[30][31][32]45 Volume correction was achieved with a single free flap harvested from the trunk in 17 cases, 9,10,12,14,17,19,21,22,27,29,36,37,39,42,44,47 with a single free flap from the limbs in 8 cases, 26,[33][34][35]40,43,45,46 and with a single free flap from the abdomen in 3 cases. The mean age of correction was 24.7 years (range, 5-59 y) 9-11,13-20,22-24,27-29,33.44,46,47 and was not available in 8 articles.…”

“…13,15,38 The total number of patients who benefited from a single flap reconstruction was 154. Complications were reported in 21 articles 9,11,[13][14][15][16]20,22,27,28,30,31,34,[38][39][40][41][43][44][45]47 and included hematoma, 11,14,16,27,28,31,41,43 infection, 9,16,30 partial flap loss, 14,20,30,38 bulkiness, 15,16,39,40,45 atrophy, 34,41 dehiscence, 31 seroma, and 43 transient facial palsy. 25 In all cases, free flaps were harvested from the trunk and limbs.…”

“…25 In all cases, free flaps were harvested from the trunk and limbs. 9,18,30,31 Structural Fat Grafting to Volume Restoration [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] Sixteen articles published between 1989 and 2011 were identified. 39,44,46 The mean follow-up was 41 months (range, 0.5-228 mo) and was not available in 4 articles.…”

“…The mean follow-up (41 mo) is close to that of patients who have undergone soft tissue restoration using structural fat grafting (43 mo). They did not report flap atrophy and noticed that, in patients who gained 3 Groin flap 11,12,14,16,17,20,22,24,25,29,31,32 12 Deep inferior epigastric perforators flap 11 1 Scapular and parascapular 17,[23][24][25]27,[30][31][32]36,37,47 11 Latissimus dorsi flap 21,24,25,31,39,41 6 Omental flap 13,15,20,23,38 5 Dorsalis pedis flap 16 1 Circumflex iliac flap 16,42 2 Gracilis flap 23 1 Radial forearm flap 25,26,30 3 Serratus flap 28,44 2 Lateral arm flap 28 1 Anterolateral thigh flap [33][34][35]40,41,43,45,46 8 The Journal of Craniofacial Surgery • Volume 25, Number 3, May 2014 Fat Grafting Versus Local/Free Flaps weight, the flap volume increased but the free tissue transfer did not alter the natural history of the disease process. First, the structural fat grafting technique has been introduced to the clinical practice more recently with respect to the microsurgical correction of soft tissue volume deficiency, which in part explains the larger number of patients treated with free tissue transfer.…”

Pediatric Thermal Injury: Acute Care and Reconstruction Update

“…The subunit principle should be applied whether a skin graft or a flap is used. 45 Sheet grafting in the acute care phase can decrease secondary reconstruction. Mesh grafts should be avoided at all costs in this region.…”