Repair of "coup de sabre" with tissue expander

Management Options for Linear Scleroderma ("En Coup de Sabre")

BACKGROUND

En coup de sabre (ECDS) is a form of linear-scleroderma, primarily affecting the face. Despite effectiveness of pharmacological interventions in the management of lesions, sequelae of cutaneous deformities are common.

OBJECTIVE

Review the existing surgical tools for the correction of "en coup de sabre" ECDS lesions and facial deformities.

MATERIALS AND METHODS

The authors conducted a literature search for reports on surgical interventions for ECDS deformations, in the electronic databases of PubMed, Scopus, and Cochrane Library Databases.

RESULTS

Twenty-six publications reporting 39 patients were found in the literature. The average age of patients was 25 ± 4.7 years. Thirty-one of the patients were females. Six methods were found in the literature for surgical correction of ECDS. Fat grafting was performed in 41% of patients, surgical reconstruction in 18%, injectable fillers in 15%, implants in 10%, botulinum toxin injections in 8%, and bone/cartilage grafts in 8%. Imaging studies of the skull and face were performed in 36% of patients. Bony defects were found in 64.3% of them.

CONCLUSION

Different surgical and minimally invasive options exist in the armamentarium of clinicians correcting ECDS deformities. Tailoring the method of correction to patient's needs and expectation is crucial in ensuring patient satisfaction.

Treatment of Linear Scleroderma (en Coup de Sabre) With Dermal Fat Grafting

Background:

Linear scleroderma, also known as “ en coup de sabre,” is a subtype of localized scleroderma that warrants aesthetic correction because it appears on the forehead region in children.

Objective:

To report dermal fat grafting as a novel and effective surgical treatment option in linear scleroderma.

Methods:

Under local anesthesia, a dermal fat graft was successfully placed into a subcutaneous pocket that was prepared underneath the depressed scar. The donor site was closed primarily.

Results:

No early or late complications developed postoperatively. After 1-year follow-up, the dermal fat graft was viable, the depressed scar was adequately augmented, and a good aesthetic result and patient satisfaction were obtained.

Conclusion:

We believe that dermal fat grafting is a cost-effective option and provides a long-lasting aesthetic outcome in the management of linear scleroderma.

Minimally invasive combined treatment for Parry-Romberg syndrome

BACKGROUND

Facial hemiatrophy, a typical manifestation of Parry-Romberg syndrome, produces massive face asymmetry, causing marked aesthetic damage and severe psychological discomfort, with repercussions to the psychophysical status of the patient. This article presents a successful combined treatment that results in resolution of symptoms and patient satisfaction.

METHODS

The authors proposed a clinic-therapeutic management comprising a customized program of bio-lipo-intense pulsed light (IPL) remodeling.

RESULTS

In 2007, at a 1-year follow-up visit, the patient presented a stable result. She is satisfied with the augmentation treatment, the new volume and contours of the face, and the resolution of the sclerosis and ochrodermia.

CONCLUSION

The authors have succeeded with a minimally invasive reconstructive technique for Romberg disease using a customized therapeutic program of poly-L-lactic acid, lipofilling, and IPL therapy. They report a case of good healing without recurrences and complications, with a good cosmetic result, and with satisfaction of the patient.

Operative Korrektur einer Sklerodermie en coup de sabre durch En-bloc-Resektion

A 15-year-old patient developed scleroderma en coup de sabre on right temple at 5 years of age. Multiple treatments (3 cycles of intravenous penicillin, topical glucocorticosteroids, topical calcipotriol, and cream PUVA phototherapy combined with topical calcipotriol) produced no improvement. The patient suffered greatly from the psychosocial stigmatization, so that the entire lesion was resected at 14 years of age. One year after the operation a thin non-sclerotic scar was present; tiny lateral areas of sclerosis not included in the operative field were unchanged. The operation greatly improved the patient's daily life. The surgical therapy of scleroderma en coup de sabre offers an interesting therapeutic alternative.

Reconstruction of Romberg Disease Defects by Omental Flap

Romberg disease is a progressive hemifacial atrophy of unknown etiology. Several methods have been described for its reconstruction. Microsurgical reconstruction, focusing on the correction of facial asymmetry and restoration of contour, has become the standard. We have succeeded a reconstructive technique for Romberg disease using by omental flap. All patients achieved good healing of the transferred omentum without recurrences and complications with a good cosmetic result on long-term follow-up. Donor-site morbidity resulting from omental free flap harvest was minimal. Based on the results of our patients in this series, the surgical results were favorable. This report describes the successful treatment of 8 patients using this approach.

Survival of grafts in coup de sabre

BACKGROUND

Treatment of coup de sabre must remain conservative until the disease is no longer in an active state. When activity has ceased, some operative intervention is safe and effective for the correction of deformity. While hair transplantation showed high survival rates for the correction of cicatricial alopecia, it has not yet been reported to be performed for the correction of coup de sabre.

OBJECTIVE

To examine the therapeutic possibility of hair transplantation for the correction of coup de sabre.

METHODS

Follicular units consisting of two to three hairs from the patient's occipital scalp were transplanted using Choi hair transplanters.

RESULTS

Ten-month follow-up studies showed an 86.5% survival rate and 10-14 cm (mean 12 cm) length of the transplanted hairs.

CONCLUSION

When coup de sabre is no longer in an active state, hair transplantation is a useful method for cosmetic improvement of the alopecia.

Successful correction of depressed scars of the forehead secondary to trauma and morphea en coup de sabre by en bloc autologous dermal fat graft

BACKGROUND

Atrophic scars of the forehead can result from various pathologic processes including morphea en coup de sabre as well as trauma. A variety of surgical techniques can be used to correct these atrophic scars.

OBJECTIVE

Soft tissue augmentation for correction of atrophic scars of the forehead using en bloc autologous dermal fat graft.

METHODS

Use of en bloc autologous dermal fat graft harvested from the hip and inserted into a pocket created under the atrophic scar in two patients with depressed scars of the forehead.

RESULTS

Overcorrection of the scars with en bloc autologous dermal fat grafts resulted in the treated areas becoming level with the adjacent skin within 3 months. Follow-up for a period of 12 months showed a perfectly level and stable graft with no further resorption.

CONCLUSION

En bloc autologous dermal fat grafting appears to be a safe technique that provides excellent cosmetic results for the correction of small to medium depressed scars of the forehead.

Classification of morphea (localized scleroderma)

OBJECTIVE

To classify and describe morphea (localized scleroderma).

DESIGN

A review of morphea and its subtypes is presented.

RESULTS

The current classification of morphea is incomplete and confusing. As knowledge of the spectrum of disease continues to evolve, the controversy and confusing nature of its multiple subtypes present a challenge for the physician who encounters a patient with this condition. Thus, we propose that morphea be classified into the following five groups: plaque, generalized, bullous, linear, and deep. This classification, based on clinical morphologic findings, will simplify the diagnostic and therapeutic approach.

CONCLUSION

Morphea represents a wide variety of clinical entities that seen to be on the opposite end of the scleroderma spectrum from systemic sclerosis. The cutaneous lesions eventually evolve from a sclerotic stage to a nonindurated stage, and residual hypopigmentation or hyperpigmentation follows. The histologic pattern in patients with morphea is similar to that in patients with progressive systemic sclerosis. Although treatment is nonstandardized, hydroxychloroquine sulfate may be beneficial.