[Microsurgical transplants for facial depressions]

From 1877 to 1991, 23 patients, 15 female and eight male, age ranging from eight to 42 years were treated for hemifacial depressions with microvascular transplants. Eight had hemifacial atrophy, four had hemifacial microsomia and one sequelae of hemangioma treatment. Twelve of these patients received paraescapular flaps, five omentum flaps, five great dorsal flaps and one fascial tensor flap. Good result was achieved in 21/23 patients with good symmetry. Two flaps were lost by vascular thrombosis. On of these patients later received a second microvascular flap with good result. Two patients presented late "reabsorption" of the flap after good result in the first year of follow-up. One of them received a second microvascular flap and again the flap lost volume in a long term follow-up. Discussion focuses on this important finding in terms of physiopathology. The results of different kinds of reconstruction are compared and the fact that dermofat flaps achieved best results is emphasized.