Simultaneous Bilateral Facial Reconstruction of a Barraquer-Simons Lipodystrophy with Free TRAM Flaps

Coessens, Bruno; Geertruyden, Jean Pierre Van

doi:10.1097/00006534-199504001-00023

Cited by 26 publications

(8 citation statements)

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“…For the past 20 years, free flap transplantation has been the ''gold standard'' for the correction of facial concave deformities. 13 The choice of free flaps include those from the groin, 14,15 radial forearm, 16 scapular, 17 parascapular, 18 latissimus dorsi, 19 transverse rectus abdominis myocutaneous (TRAM), 20 deep inferior epigastric perforator (DIEP), 21 superficial inferior epigastric, 22 and omental free flaps. 23,24 Each flap has its own advantages and disadvantages, and no particular flap is considered a universal choice for treating facial concave deformities.…”

Section: Discussionmentioning

confidence: 99%

“…16 Muscle flaps, such as the serratus, latissimus dorsi, and TRAM, have long vascular pedicles and can provide sufficient tissue volume. 19,20,25 Although they can be used for extensive contour defects, they can exhibit unpredictable muscle contracture postoperatively. Additionally, muscle flaps do not form a smooth facial contour and produce relatively serious functional injury of the donor site.…”

Section: Discussionmentioning

confidence: 99%

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Anterolateral thigh adipofascial flap for the restoration of facial contour deformities

Jin¹,

Teng²,

Xu³

et al. 2010

Microsurgery

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From January 2000 to May 2008, 50 patients with facial contour deformities underwent soft tissue augmentation with 51 anterolateral thigh (ALT) adipofascial flaps. Fifty flaps survived with no complications; partial fat necrosis occurred in one flap. Mean follow-up was 16 months. Flaps ranged from 10 x 6 cm to 20 x 12 cm. Perforators were found in 50 flaps, 43 musculocutaneous perforators (84.3%) and 7 septocutaneous perforators (13.7%), with a mean of 2.5 perforators per flap. In one flap (2.0%), no perforator was found. In this case, we used an anteromedial thigh adipofascial flap using the medial branch of the descending branch of lateral circumflex femoral artery as the vascular pedicle. Relatively symmetric facial contour was achieved in 20 cases. In 30 cases, adjunctive procedures including flap debulking, fat injection, and resuspension were necessary, and 23 patients achieved satisfactory outcomes. We conclude that the ALT adipofascial flap can be successfully elevated and transplanted for the correction of soft tissue facial defects. This flap can provide tissue to fill large defects, and posses the qualities of pliability, an excellent blood supply, ease of suspension and fixation, and minimal morbidity at the donor site.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anterolateral thigh adipofascial flap for the restoration of facial contour deformities

Jin¹,

Teng²,

Xu³

et al. 2010

Microsurgery

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“…There are several requirements for the tissue or material for tissue augmentation: (1) it must be malleable, to be formed according to defect; (2) once in position, it must undergo minimal change in size and position; and (3) the texture should be soft and should feel similar to subcutaneous tissue. Many free flaps have been applied in clinical patients, including groin, 5-7 radial forearm, 8 scapular, 9 parascapular, 10,11 latissimus dorsi flap, 12 serratus, 13 TRAM, 14 omental free flap, 15,16 superficial inferior epigastric flap, 17 deep inferior epigastric perforator flap, 18 and anterolateral tight flap. 19 However, a consensus on the ideal method has not yet been reached, and investigations to discover the ideal flap continues.…”

Section: Discussionmentioning

confidence: 99%

“…8 Muscle flaps such as lattisimus dorsi, serratus, and TRAM with its longer vascular pedicle, create an abundance of available tissue and provide successful augmentation for wide contour deformity. [12][13][14] Although they supply bulky tissue after operation, they could not provide lasting contour and symmetry because of the unpredictable atrophy of muscles. However, muscle flap does not follow replacing like tissue with like in reconstructive principles and it does not provide smooth contoured surface in the reconstructed face.…”

Section: Discussionmentioning

confidence: 99%

Soft tissue augmentation for restoration of facial contour deformities using the free SCIA/SIEA flap

et al. 2008

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Reconstruction for facial contour deformities is still a challenging process and treatment for most cases is achieved only by soft tissue augmentation. The use of free tissue transfer offers the advantage of one step vascularized soft tissue augmentation. This article summarized the authors' use of de-epithelialized free superficial circumflex iliac artery/superficial inferior epigastric artery flap for facial contour deformities. Of these patients, two had hemifacial microsomia, one depressed scar, and one had hemifacial progressive atrophy. Stable restoration of the facial contour was achieved in all patients. The advantages of this flap are numerous. Two surgical teams may work at the same time for flap harvesting and recipient area preparation. A wide flap may be planned for large contour deformity to achieve one single stage augmentation. Pedicle course of this flap allows primary de-fating without disturbing distal flap circulation when in need of a thin flap for mild contour deformity. Donor site may be closed with bikini (abdominoplasty) incision, which has excellent esthetic outcome compared to other flaps.

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“…10 Muscle is more consistent than fat tissue, and the attachment of the muscle surface on the surrounding tissue is more secure than that of adipose tissue. The deepithelialized skin component creates smoother contouring of the face.…”

Section: Discussionmentioning

confidence: 99%

Facial contour restoration in Barraquer‐Simons syndrome using two free tram flaps: Presentation of two case reports and long‐term follow‐up

Goossens

Coessens

2002

Microsurgery

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Barraquer-Simons syndrome, a disorder of unknown etiology, is characterized by a cephalothoracic lipodystrophy. We present 2 patients treated with a bilateral free transverse rectus abdominis myocutaneous (TRAM) flap to restore facial contour. Our technique of using a muscle component to fill the cheek defect was based on our experience with free muscle transfer in facial reanimation. In comparison with adipose tissue, muscle tissue does not show a tendency for ptosis because of its consistency and firm attachment of the muscle surface to the surrounding tissues. These cases demonstrate the possibility for the use of simultaneous dissection of the face and flaps, and the reliability of the vascular pedicle. The stability of the abdominal wall was secured by closure of the rectus sheath over Teflon mesh, which has been proven to prevent hernia. Our long-term follow-up demonstrates a stable symmetrical facial appearance.

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Simultaneous Bilateral Facial Reconstruction of a Barraquer-Simons Lipodystrophy with Free TRAM Flaps

Cited by 26 publications

References 0 publications

Anterolateral thigh adipofascial flap for the restoration of facial contour deformities

Anterolateral thigh adipofascial flap for the restoration of facial contour deformities

Soft tissue augmentation for restoration of facial contour deformities using the free SCIA/SIEA flap

Facial contour restoration in Barraquer‐Simons syndrome using two free tram flaps: Presentation of two case reports and long‐term follow‐up

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