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Soft tissue reconstruction in patients with hemifacial microsomia: review of the literature
Nicholas Sinclair MD, Bahar Bassiri Gharb MD, Fatma Betul Tuncer MD, Frank Papay MD,
Antonio Rampazzo MD
Cleveland Clinic Foundation, Integrated Plastic Surgery
2018-02-04
Presenter: Nicholas Sinclair, MD
Affidavit:
The resident has been an integral member of the team in performing the comprehensive literature review, writing the abstract, and creating the presentation.
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background
While there are several reports in the literature regarding management of bony deficiency in hemifacial microsomia, there has been little interest regarding management of the soft tissue deformity. This review addresses the correction of soft tissue deformities in patients with hemifacial microsomia.
Method
A comprehensive literature review regarding the management of soft tissue reconstruction in patients with hemifacial microsomia was performed between 1970 and 2017. Data collected included patient characteristics, disease severity, reconstructive procedure, previous surgeries, concomitant procedures, complications, follow-up length, and level of evidence. Fisher exact test was used to assess differences in complications between reconstructions performed with free tissue transfer and fat grafting.
Results
The literature search yielded 97 articles that met eligibility requirements. Eleven patients underwent simultaneous reconstruction of the soft tissue and bone defects with a free osteocutaneous flap. Sixty patients underwent reconstruction of the soft tissue defect with a free fasciocutaneous or muscle flap. Eighty-four patients underwent fat grafting alone or in combination with other procedures. Free gracilis or latissimus dorsi flaps were used for facial reanimation.
Conclusions
Severe soft tissue and bone defects should be addressed with free osteocutaneous flaps. Severe soft tissue defects with mild mandibular deformities should be addressed with free adipo-cutaneous flaps or with serial fat grafting. Minor defects can be corrected using fat grafting, pedicled flaps, bone contouring, allo- or auto-graft either alone or in combination. Anomalies of the vessels and nerves should be kept in mind when free flaps are utilized or facial reanimation is planned.
