Facial contour restoration in Barraquer‐Simons syndrome using two free tram flaps: Presentation of two case reports and long‐term follow‐up

Abstract

Barraquer-Simons syndrome, a disorder of unknown etiology, is characterized by a cephalothoracic lipodystrophy. We present 2 patients treated with a bilateral free transverse rectus abdominis myocutaneous (TRAM) flap to restore facial contour. Our technique of using a muscle component to fill the cheek defect was based on our experience with free muscle transfer in facial reanimation. In comparison with adipose tissue, muscle tissue does not show a tendency for ptosis because of its consistency and firm attachment of the muscle surface to the surrounding tissues. These cases demonstrate the possibility for the use of simultaneous dissection of the face and flaps, and the reliability of the vascular pedicle. The stability of the abdominal wall was secured by closure of the rectus sheath over Teflon mesh, which has been proven to prevent hernia. Our long-term follow-up demonstrates a stable symmetrical facial appearance.

Clinical Features and Metabolic and Autoimmune Derangements in Acquired Partial Lipodystrophy

“…Management of subcutaneous fat loss is challenging and often frustrating for physicians and surgeons. Numerous cosmetic procedures have been attempted to correct cosmetic disfigurement, including paraffin injections 38 , acrylic prosthesis 75 , silicon implants 34,98,131,132 (Patient 29), facial injection of aspirated fat from thighs 48 (Patient 29), fascial and fat grafts from thighs 11 (Patient 24), free dermal fat grafts 85,191 , free anterolateral thigh flaps 70 , scapular grafts (Patient 18), temporalis muscle flaps 151,172 , and bilateral facial reconstruction with transverse rectus abdominis myocutaneous grafts 41,67 . Although improvement of facial appearance has been reported 41,85,191 , failure may occur.…”

Reconstrucción compleja de la cavidad oral mediante dos colgajos simultáneos de peroné y radial

“…9,10,15 También, hay descritas asociaciones de dos colgajos libres para reconstrucción de partes blandas: radial bilateral para cavidad oral; 2 para esó-fago; 16 para defectos de tercio medio tras heridas por arma de fuego 17 y dos colgajos de TRAM para restaurar el contorno facial. 18 Asimismo, hay publicaciones de tres colgajos libres microvascularizados simultáneos: peroné con dos radiales, 14 e incluso de cinco colgajos libres microvascularizados: radial bilateral, gracilis bilateral inervado y miocutáneo de recto abdominal. 19 De todas estas posibles combinaciones la asociación de peroné y radial tiene una serie de ventajas.…”

Subcutaneous fat in normal and diseased states

“…Areas of concern include posttraumatic tissue damage, 218,219 such as that seen in extensive deep burns, avulsions, tumor resections, or postsurgical deformity, as well as congenital or acquired diseases of the subcutaneous fat, including lipodystrophy. [220][221][222] Local and free flaps, autologous adipose tissue grafts, and natural and synthetic fillers, are widely used for tissue contouring in these clinical settings. [220][221][222][223] Many of these treatment modalities, however, have limitations and disadvantages.…”

“…[220][221][222] Local and free flaps, autologous adipose tissue grafts, and natural and synthetic fillers, are widely used for tissue contouring in these clinical settings. [220][221][222][223] Many of these treatment modalities, however, have limitations and disadvantages. Autologous adipose tissue grafts are desirable because they are derived from ubiquitous and accessible sources of fat and because they avoid use of materials that elicit foreign-body type reactions.…”