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

Abstract

Progressive hemifacial atrophy (PHA) is characterized by slow and progressive atrophy usually of one side of the face. PHA affects primarily the subcutaneous fat and muscle tissues, but may involve the bone. The cause is unknown. The treatment is symptomatic and directed at augmentation of the deficient soft-tissue volume. The reconstructive procedures may combine fat grafts, dermis fat grafts, pedicle flaps, bone grafts, microvascular free flaps, and alloplastic implants. We report a patient with of PHA whose condition was treated with a free latissimus dorsi (LD) perforator flap. The LD perforator flap was suitable for the large defect of the patient. It could easily be tailored and thinned to follow the facial contour. Minor revisions were needed for esthetic reasons. There was neither significant downward gravitation nor wasting of the flap. 23 months later, the natural appearance of the face was maintained.

Anterolateral thigh adipofascial flap for the restoration of facial contour deformities

“…16 Muscle flaps, such as the serratus, latissimus dorsi, and TRAM, have long vascular pedicles and can provide sufficient tissue volume. 19,20,25 Although they can be used for extensive contour defects, they can exhibit unpredictable muscle contracture postoperatively. Additionally, muscle flaps do not form a smooth facial contour and produce relatively serious functional injury of the donor site.…”

“…For the past 20 years, free flap transplantation has been the ''gold standard'' for the correction of facial concave deformities. 13 The choice of free flaps include those from the groin, 14,15 radial forearm, 16 scapular, 17 parascapular, 18 latissimus dorsi, 19 transverse rectus abdominis myocutaneous (TRAM), 20 deep inferior epigastric perforator (DIEP), 21 superficial inferior epigastric, 22 and omental free flaps. 23,24 Each flap has its own advantages and disadvantages, and no particular flap is considered a universal choice for treating facial concave deformities.…”

Esthetic Restoration in Progressive Hemifacial Atrophy (Romberg Disease)

“…[1][2][3][4][5][6][7][8] Free Microsurgical Transfer to Volume Restoration Thirty-nine articles were included in this second group and were published from 1974 to 2011. 12,21,25,26,[30][31][32]45 Volume correction was achieved with a single free flap harvested from the trunk in 17 cases, 9,10,12,14,17,19,21,22,27,29,36,37,39,42,44,47 with a single free flap from the limbs in 8 cases, 26,[33][34][35]40,43,45,46 and with a single free flap from the abdomen in 3 cases. The mean age of correction was 24.7 years (range, 5-59 y) 9-11,13-20,22-24,27-29,33.44,46,47 and was not available in 8 articles.…”

“…In the remaining cases, volume restoration was obtained using 2 free flaps in 4 articles (31 patients), 11,20,28,41 3 free flaps in 5 articles (194 patients), 16,23,24,31,32 and 5 free flaps in 1 article (1 patient). 39,44,46 The mean follow-up was 41 months (range, 0.5-228 mo) and was not available in 4 articles. Complications were reported in 21 articles 9,11,[13][14][15][16]20,22,27,28,30,31,34,[38][39][40][41][43][44][45]47 and included hematoma, 11,14,16,27,28,31,41,43 infection, 9,16,30 partial flap loss, 14,20,30,38 bulkiness, 15,16,39,40,45 atrophy, 34,41 d...…”

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

“…For facial defects, the versatility of free perforator f laps is well described in the literature, such as a TDAP f lap for temporomasseteric contour correction, 15 a latissimus dorsi perforator f lap for hemifacial atrophy, 16 or a deep epigastric artery perforator f lap for craniofacial contour deformities. 17 Several options can be offered for reconstruction of facial CMs.…”