Treatment of Progressive Hemifacial Atrophy by Cartilage Graft and Free Adipofascial Flap Combined with 3D Planning and Printing

Abstract

rogressive hemifacial atrophy (PHA) is also named Parry-Romberg syndrome, which was first reported by Parry in 1825 and established as a syndrome by Romberg in 1846. 1 It is an infrequent disease characterized by progressive atrophy of skin, soft tissue, muscles, and underlying bone structures in a hemifacial distribution. 2 This rare disorder usually begins in the first decade of life, and slowly progresses for 2 to 20 years before stabilizing. 3 The pathogenesis of PHA is not well understood. Trauma, infection, immune abnormality, cranial vascular malformation, and sympathetic dysfunction have all been implicated in this disease. 4 Although immunosuppressive treatment may slow down the progression of the disease, affected patients with obvious facial Background: Progressive hemifacial atrophy (PHA) is a rare disease characterized by progressive atrophy of skin, soft tissue, muscles, and underlying bone structures. For severe PHA patients with obvious bone deformities, skeletal framework reconstruction is needed in addition to soft-tissue augmentation. The authors propose a new combinatorial surgical method using rib cartilage graft and free adipofascial flap for restoring facial symmetry. To improve the surgical accuracy, preoperative three-dimensional planning and printing was used. Methods: Twelve patients with severe facial atrophy were included in the authors' study. Three-dimensional facial image analyses were performed preoperatively to quantify the facial asymmetry. Rib cartilages were harvested and sculptured to the appropriate shape created by three-dimensional planning and fixed to the atrophic bone. The circumflex scapular artery-based adipofascial flap was transplanted to repair soft-tissue deficiency. A residual small monitor flap was left with the adipofascial flap. A revision surgery was performed to perfect the repair if the contour was suboptimal 6 months postoperatively. Results: The adipofascial flaps survived in all 12 patients. All patients achieved good healing without complications. At 1 more year after surgery, the rib cartilage was still in position and rarely absorbed. The morphologic and volumetric difference between the affected side and the unaffected side was improved significantly postoperatively. All patients were satisfied with the results, and no more additional operations were required. Conclusion:The combinatorial surgery of rib cartilage graft and free adipofascial flap in the setting of three-dimensional planning and printing can be a good choice in restoring facial symmetry in severe cases of PHA.

Sculpting the future: A narrative review of 3D printing in plastic surgery and prosthetic devices

“…19 For severe hemifacial atrophy, 3D planning and printing guided surgery using rib cartilage grafts and adipo-fascial flaps, with 42% needing secondary revision and significant postoperative volume improvement. 20 Figure 1 presents an overview of 3D printing milestones in plastic surgery and prosthetics.…”

Discussion: Treatment of Progressive Hemifacial Atrophy by Cartilage Graft and Free Adipofascial Flap Combined with Three-Dimensional Planning

“…I n this issue, He et al describe their experience treating progressive hemifacial atrophy (PHA) using rib cartilage grafting and free adipofascial flap transfer, 1 and also using virtual surgical planning to help guide their intraoperative decision-making. PHA, also known as Parry-Romberg syndrome, is a degenerative condition of the face characterized by a unilateral, gradual, and progressive atrophy of the skin, subcutaneous tissue and, in severe cases, muscle and bone.…”