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Surgical algorithm for management of HIV lipodystrophy.

Steven P Davison1, Joseph Timpone, Catherine M Hannan

  • 1Washington, D.C. From the Department of Plastic Surgery and Division of Infectious Disease, Department of Medicine, Georgetown University Medical Center.

Plastic and Reconstructive Surgery
|December 20, 2007
PubMed
Summary

This study presents a treatment algorithm for facial deformities in patients with human immunodeficiency virus (HIV) lipodystrophy syndrome. Autogenous tissue grafting, including liposuction aspirate and resected breast tissue, showed promising results for facial wasting and buffalo hump.

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Area of Science:

  • Plastic Surgery
  • HIV Medicine
  • Reconstructive Surgery

Background:

  • Highly active antiviral therapy for HIV can cause facial lipoatrophy and lipodystrophy.
  • Facial wasting and buffalo hump deformities are characteristic of treated HIV disease.
  • Cystic parotid degeneration can also contribute to facial disfigurement.

Purpose of the Study:

  • To outline an algorithm for treating facial deformities in HIV lipodystrophy syndrome.
  • To evaluate the efficacy of autogenous tissue reconstruction for these deformities.

Main Methods:

  • Treatment of 27 patients with facial wasting and/or buffalo hump deformities.
  • Liposuction of buffalo hump with autologous fat grafting to the face.
  • Ultrasound-assisted liposuction for recurrent or fibrous humps.

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  • Autografting with resected breast tissue for gynecomastia.
  • Superficial parotidectomy with parotid tissue grafting for cystic degeneration.

    • Main Results:

    • Approximately 40-50% graft survival observed after buffalo hump liposuction and facial fat grafting.
    • Successful reconstruction using resected breast tissue in two patients.
    • Effective treatment of cystic parotid degeneration through parotidectomy and grafting.

    Conclusions:

    • An algorithm for treating HIV lipodystrophy-associated facial deformities is presented.
    • Emphasis on long-term outcomes using autogenous tissues for reconstruction.
    • Autologous fat grafting and tissue reconstruction offer viable solutions for facial disfigurement.