Craniofacial microsomia soft-tissue reconstruction comparison: inframammary extended circumflex scapular flap versus serial fat grafting.

BACKGROUND: The authors investigated the use of serial autologous fat grafting to restore soft-tissue contour in craniofacial microsomia patients.

METHODS: Patients with moderate to severe craniofacial microsomia were divided into two groups. Microvascular free flap patients had reconstruction with inframammary extended circumflex scapular flaps at skeletal maturity (n = 10). Alternatively, patients had fat grafting during multiple staged operations for mandible and ear reconstruction (n = 21). Sex, age, severity of deformity [determined by OMENS (orbital deformity, mandibular hypoplasia, ear deformity, nerve involvement, and soft-tissue deficiency) classification], number of procedures, operative times, and augmentation volumes were recorded. A digital three-dimensional photogrammetry system was used to determine "final fat take" and symmetry (affected side versus unaffected side). Physician and patient satisfaction were elicited.

RESULTS: Microvascular free flap and fat grafting groups had similar OMENS scores, 2.4 and 2.3, and similar mean prereconstruction symmetry scores, 74 percent and 75 percent, respectively. Although the mean number of procedures was less for the microvascular free flap group versus the fat grafting group (2.2 versus 4.3), the combined surgical time was greater for the microvascular free flap group. The complication rate for the microvascular free flap group was 12 percent and that for the fat grafting group was 5 percent. The mean microvascular free flap volume implanted was 131 cc, with a final measured volume of 106 cc. Mean fat grafting volume injected per case was 33 cc, with total fat injections of 146 cc and a final measured volume of 121 cc. There was a mean fat loss of 25 cc and 83 percent fat take. Symmetry score was 121 percent for the microvascular free flap group and 99 percent for the fat grafting group. No statistically significant difference in patient or physician satisfaction was noted.

CONCLUSION: Serial fat grafting provided a useful alternative to microvascular free tissue transfer after skeletal reconstruction.