Soft tissue correction of craniofacial microsomia and progressive hemifacial atrophy

Moderate to severe soft tissue deficits can exist with craniofacial microsomia or progressive hemifacial atrophy. The authors reviewed the surgical correction of these defects, including serial autologous fat grafting and parascapular free tissue transfer.

Recently treated patients at the Institute of Reconstructive Plastic Surgery at NYU Medical Center were identified. Patients with microvascular free flap underwent reconstruction with parascapular flaps. These flaps have been modified from previously reported inframammary extended circumflex scapular flaps. Demographic information, operative interventions, complications, and outcomes were reviewed and analyzed. The clinical outcomes of these patients were compared with previously reported patients who underwent serial autologous fat grafting.

Five patients were recently treated with 7 parascapular flaps. The mean age of the patients at the time of parascapular flap reconstruction was 13.1 years. These were compared to those previously reported who have undergone serial autologous fat grafting. The mean number of procedures was less for the free tissue transfer cohort. There were no microvascular complications because all free flaps survived. One patient had wound dehiscence of the donor site managed with local wound care and healing by secondary intention.

For patients undergoing multiple-stage reconstruction of craniofacial microsomia, serial fat grafting is a useful tool for soft tissue reconstruction. Alternatively, in those patients with isolated soft tissue hypoplasia, such as progressive hemifacial atrophy, microvascular free tissue transfer is a safe and efficient option.