EVOLUTION OF MICROSURGICAL CORRECTION IN FACIAL CONTOUR DEFORMITIES: REMARKS ON 22 CONSECUTIVE FLAPS

Aim: Facial contour deformities with hemifacial or bilateral tissue atrophy can have many different etiologies, both congenital and acquired. Microsurgical reconstruction is currently the treatment of choice for facial soft tissue integration, to obtain satisfactory and long-lasting countour restoration. Methods. Our experience includes 20 patients with facial contour deformity, treated with the transfer of 22 microsurgical flaps, from 1990 to 2007. We have experienced an evolution in flap selection: we used the scapular flap in our first four patients and then adopted the perforator flaps (ALT,DIEP,SGAP, with a total of 14 perforator flaps in 13 patients). Our current standard approach in these cases is the adiposal DIEP flap. Results. There were no flap losses in this series of 22 flaps, two patients developed postoperative hematoma and flap revision was performed in eight patients (liposuction,fat graft,scar revision). Unlike our previous experience with the scapular plaps, using the perforato flaps we have been able to reduce donor site morbidity , and obtain better contour restoration, as perforator flaps are more easily modelled. The introduction of adiposal DIEP flaps has led to further reduction of donor site morbidity, with minor residual scarring in the suprapubic region, and a softer and more natural reconstruction, thanks to the lack of a dermal component. Conclusion. Based on our experience, the adiposal DIEP flaps can currently be considered the gold standard in the treatment of facial contour deformieties.