Marriage of hard and soft tissues of the face revisited: when distraction meets microsurgery

Patients with craniofacial anomalies can have hard and soft tissue deficiencies. In some cases, distraction osteogenesis can restore the bony deficiencies, but the soft tissue contour defect remains problematic. For these patients, the union of distraction osteogenesis and microvascular free flaps (MVFF) can restore bone and soft tissue form and function.

A retrospective review of all patients treated with mandibular distraction osteogenesis between 1989 and 2005 was performed. A similar review of all patients treated with MVFFs was performed. These 2 cohorts were cross-referenced to identify all patients treated with both procedures. The indications, choices, safety, and efficacy of MVFF reconstruction of facial soft tissues following mandibular reconstruction are reviewed.

Over a 16-year period, 141 patients underwent mandibular distraction osteogenesis; 8 patients treated with mandibular distraction osteogenesis subsequently underwent 12 MVFFs. Patient diagnoses included unilateral craniofacial microsomia (n = 2), bilateral craniofacial microsomia (n = 3), Goldenhar syndrome (n = 1), Nager syndrome (n = 1), and Treacher-Collins syndrome (n = 1). Free flap choices included 10 parascapular fasciocutaneous, 1 parascapular osteofasciocutaneous, and 1 fibular osteocutaneous flap. Four patients underwent staged bilateral free flaps. A single case of partial flap loss was the only complication. In all cases, facial contour was improved following MVFF transfer.

In certain circumstances, facial rehabilitation may require the marriage of craniofacial and microsurgical techniques to restore both form and function. In these cases, mandibular distraction osteogenesis and MVFFs can be safely and effectively combined.