Management of facial contour deformities with deepithelialized lateral intercostal free flap

Ten cases suffering from facial contour deformities caused by loss of subcutaneous tissue are presented. Three cases had hemifacial microsomia, 3 had postmaxillectomy collapsed cheek, while the remaining 4 patients had Romberg's disease. All cases were treated by the insertion of a deepithelialized, revascularized lateral intercostal flap. The flaps used had dimensions ranging from 9 cm x 6 cm to 12 cm x 14 cm. The vascular pedicle of the flap is the lateral cutaneous branch of one of the lower four posterior intercostal bundles (usually the tenth or the eleventh). The flap is designed to have the pedicle in its center, thus allowing defattening of the edges at the primary surgery and minimizing the need for secondary debulking. Nine flaps were successful and one failed. All successful flaps gave a permanent and satisfactory correction of the deformity. The difficulties and advantages of the flap are presented.