Free latissimus dorsi perforator flap for reconstruction of hemifacial atrophy: Case report

Forehead reconstruction with a custom-made three-dimensional titanium implant in a Parry-Romberg syndrome patient

Parry-Romberg syndrome is a rare neurocutaneous syndrome characterized by progressive shrinkage and degeneration of the tissues usually on only one side of the face. It is usually difficult to restore the facial contour due to skin tightness. In this case report, we report a forehead reconstruction with custom-made three-dimensional (3D) titanium implant of a Parry-Romberg syndrome patient who was treated with multiple fat grafts but had limited effect. A 36-year-old man presented with hemifacial atrophy. The disease progressed from 5 to 16 years old. The patient had alopecia on frontal scalp and received a surgery using tissue expander. The alopecia lesion was covered by expanded scalp flap done 22 years ago. Also, he was treated with fat grafts on depressed forehead 17 years ago. However, it did not work sufficiently, and there was noted depressed forehead. We planned to make 3D titanium implant to cover the depressed area (from the superior orbital rim to the vertex). During the operation, we confirmed that the custom-made 3D implant accurately fit for the depressed area without any dead spaces. Previously depressed forehead and glabella were elevated, and the forehead contour was improved cosmetically. A custom-made 3D titanium implant is widely used for skull reconstruction and bring good results. In our case, the depressed forehead of a Parry-Romberg syndrome patient was improved by a 3D titanium implant.

Reconstruction of Head and Neck Capillary Malformations With Free Perforator Flaps for Aesthetic Purposes

BACKGROUND

Capillary malformations (CMs) are composed of dilated capillaries and venules in the dermis layer. They appear as pink- or purple-colored lesions on the involved skin and usually follow a dermatomal distribution. Generally, laser treatment is considered the treatment of choice; however, in some patients, a surgical approach should be considered. This article presents the authors' experiences with free perforator flap transfer to the head and neck after resection of CMs for aesthetic purposes.

PATIENTS AND METHODS

A total of 5 patients with CMs on their head and neck underwent operations for aesthetic purposes. After lesion debulking, defect sizes were measured and precise flaps were designed. A primary flap-thinning procedure was needed in obese patients before flap inset. The donor site was closed primarily in 4 cases.

RESULTS

Thoracodorsal artery perforator free flaps were performed in all patients. The average size of harvested flaps was 146.8 cm. All flaps survived without recurrence of CM on the skin paddle of the transferred flap. Aesthetic restoration and high patient satisfaction were achieved after the surgery.

CONCLUSIONS

The authors used free flaps to improve aesthetic outcomes, which have been used for reconstruction after trauma and malignancy. Free perforator flap transfer should be considered a valuable option for head and neck CMs.

Superficial temporal fascial flap plus lipofilling for facial contour reconstruction in bilateral progressive facial hemiatrophy

Progressive facial hemiatrophy (PFH) was first described by Parry in 1825 and later by Romberg in 1846 and was also known as Parry-Romberg syndrome. Progressive facial hemiatrophy, as the name suggests, usually has unilateral presentation. However, bilateral manifestation has been reported in 5-10% of the cases. It is a rare disorder with few cases reported. Treatment involves augmentation of the atrophic region and restoration of symmetry of the face. Because many tissues are needed, it is very difficult to treat. In this article we report the use of a superficial temporal fascial flap plus lipofilling to treat bilateral progressive facial hemiatrophy. We obtained good facial volume, smooth contour, and soft palpation. It is safer, simple to perform, and more cost effective than free tissue transfer. It is a suitable technique of choice in the treatment of bilateral progressive facial hemiatrophy.