Parascapular free flap and fat grafts: Combined surgical methods in morphological restoration of hemifacial progressive atrophy

Background: Progressive hemifacial atrophy, widely referred to as Parry-Romberg syndrome or Romberg's disease, is a rare pathologic process characterized by an acquired, idiopathic, self-limited, unilateral atrophy of the face, variably involving, skin, subcutaneous tissues, fat, muscle and, less frequently, the underlying bone structures. Methods: Restoration of contour and symmetry is the main challenge in cases of Parry-Romberg syndrome; there are several different reconstructive techniques directed at augmentation of deficient soft-tissue volume. The present study describes the authors' own experience with deepithelialized free parascapular flap transfer combined with Coleman's lipoinjection in treatment of four severe cases affected by Parry-Romberg syndrome. Results: The free microvascular parascapular flap, harvested and transferred for facial contour reconstruction, provided large volumes of tissue at the location of the greatest contour defect. It also has proven useful in restoring atrophic tissues trophism. To achieve the finest reconstructive result, Coleman's lipoinjection technique was used for a modification of the free parascapular flap contour, to restore adjacent atrophic areas, and to treat the remaining small or moderate defects. Conclusions: Free parascapular flap transfer combined with Coleman's lipoinjection, according to the authors' results, is the procedure of choice for facial contour restoration. Together, they can provide an excellent reconstructive solution directed at restoration of facial morphology, in terms of natural appearance and long-lasting results, with minimal donor-site morbidity.