Background: Since our first review of microsurgical correction of facial contour deformities in 19 patients with craniofacial malformations, we have treated an additional 76 patients (n = 19 + 76 = 95). Here, we review the indications, choices, safety, efficacy, complications, and technical refinements. A treatment algorithm is presented.
Methods: A retrospective chart review of all patients who underwent microvascular reconstruction of the face and all patients with craniofacial dysmorphology was performed. Between 1989 and 2004, a total of 95 patients with the following diagnoses were identified: craniofacial microsomia (n = 73), Treacher Collins syndrome (n = 8), severe orbitofacial cleft (n = 12), and severe micrognathia (n = 2). All patients underwent microsurgical facial reconstruction with a superficial inferior epigastric, groin, circumflex scapular, or fibula flap. Flap revisions, complications, and non-free flap related surgery were reviewed. All patients were followed for a minimum of 1 year (range 1-15 years).
Results: The mean age at microvascular reconstruction was 11 years (range = 4-27 years). Flap choices included: superficial inferior epigastric (n = 4), groin (n = 3), circumflex scapular (n = 105), or fibula (n = 2). 78 patients underwent unilateral and 17 patients underwent bilateral (1/17 immediate) reconstructions. Postoperative complications included: total flap loss (n = 1), partial flap loss (n = 1), re-explorations (n = 1), and hematoma (n = 5). All patients had a subjective improvement in facial contour, symmetry, skin tone, and color. 63/73 patients with craniofacial microsomia underwent non-free flap-related surgery, usually mandibular/ear reconstruction, whereas 7/8 Treacher Collins syndrome patients, 12/12 severe orbitofacial cleft patients, and 2/2 severe micrognathia patients underwent additional procedures.
Conclusions: Microsurgical flaps have markedly improved our ability to restore craniofacial contour in patients with craniofacial malformations. In selected patients, we choose primary midface augmentation with free vascularized tissue in order to restore form and function. Microsurgical flaps in patients with craniofacial malformations are safe, effective, and reliable.