Soft tissue augmentation for restoration of facial contour deformities using the free SCIA/SIEA flap

Abstract

Reconstruction for facial contour deformities is still a challenging process and treatment for most cases is achieved only by soft tissue augmentation. The use of free tissue transfer offers the advantage of one step vascularized soft tissue augmentation. This article summarized the authors' use of de-epithelialized free superficial circumflex iliac artery/superficial inferior epigastric artery flap for facial contour deformities. Of these patients, two had hemifacial microsomia, one depressed scar, and one had hemifacial progressive atrophy. Stable restoration of the facial contour was achieved in all patients. The advantages of this flap are numerous. Two surgical teams may work at the same time for flap harvesting and recipient area preparation. A wide flap may be planned for large contour deformity to achieve one single stage augmentation. Pedicle course of this flap allows primary de-fating without disturbing distal flap circulation when in need of a thin flap for mild contour deformity. Donor site may be closed with bikini (abdominoplasty) incision, which has excellent esthetic outcome compared to other flaps.

Anterolateral thigh adipofascial flap for the restoration of facial contour deformities

“…Additionally, muscle flaps do not form a smooth facial contour and produce relatively serious functional injury of the donor site. 2 An omental free flap has a long and large vascular pedicle, and it can provide abundant fat tissue for a large defect. However, the amount of fat tissue in the donor site is unpredictable, and the abdomen must be opened.…”

“…31,32 The application of some free flaps without epidermis for facial augmentation often results in the dermis sticking to the subcutaneous tissue at the recipient site. 2,33 The adhesion and fibrosis of the dermis can easily result in contraction, and prevents the facial skin from becoming smooth and round. 2,33 In the transplanted ALT adipofascial flap, the fat layer adheres to the subcutaneous tissue to avoid contraction and produces a relatively smooth facial morphology, and the fascia adheres to the layer of the superficial musculoaponeurotic system (SMAS), which is consistent with normal facial anatomy.…”

“…2,33 The adhesion and fibrosis of the dermis can easily result in contraction, and prevents the facial skin from becoming smooth and round. 2,33 In the transplanted ALT adipofascial flap, the fat layer adheres to the subcutaneous tissue to avoid contraction and produces a relatively smooth facial morphology, and the fascia adheres to the layer of the superficial musculoaponeurotic system (SMAS), which is consistent with normal facial anatomy. Additionally, the thick and tenacious fascia lata can be suspended to the fascia of the temporalis and/or the periosteum of the zygomatic bone and infraorbital margin to effectively prevent flap sagging.…”

“…2 We did not employ this technique because the location of the skin island cannot be identified accurately preoperatively, and a larger scar will be left at the donor site. Furthermore, primary thinning cannot be carried out at the part of the flap with the skin island, thus leaving an uneven surface and potentially requiring a secondary surgery for excision of the skin island and thinning the flap.…”

“…The texture of the material should be soft, and have a feel similar to subcutaneous tissue. 1,2 The development of microsurgical techniques has provided innovative options for facial contour reconstruction.…”