Salvage of silicone-treated facial deformities using autogenous free tissue transfer.
BACKGROUND
Silicone, in the form of injectable liquid and prosthetic blocks, has been used to correct facial contour defects. However, silicone also has been associated with many complications including malposition, dyschromia, dysesthesia, contractures, infection, and fistula. Complications related to injectable-liquid and prosthetic-block silicone use in treatment of facial deformities pose a challenging surgical dilemma.


METHODS
Over a 15-year period, microvascular free flap technique has been used successfully as a surgical tool to correct severe soft-tissue complications of the face resulting from silicone treatment of facial contour deformities. Surgical treatment guidelines, methods, and results for treating this difficult problem with free tissue transfer are presented.


RESULTS
In 23 patients, 24 free tissue transfers (22 inframammary extended circumflex scapular free flaps and two superficial inferior epigastric free flaps) were performed. Flap survival was 100 percent. Both hematoma and skin necrosis were encountered in three of 24 cases (12.5 percent). Revisional surgery combined with aesthetic surgical procedures was required in 20 of 24 cases (83 percent).


CONCLUSIONS
We recommend the following surgical treatment guidelines for this unique subset of patients: silicone excision with immediate microvascular free flap reconstructive procedure when the skin and soft tissue are mildly to moderately affected, or silicone excision with delayed reconstructive procedure when the skin and soft tissue are severely affected. Free tissue transfer is a useful surgical tool for salvaging severe facial skin and soft-tissue deformities caused by previous silicone treatment.
Chiu
Ernest S
ES
Division of Plastic & Reconstructive Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA.
Sharma
Sheel
S
Siebert
John W
JW
D000273:Adipose Tissue / Q000473:pathology; D000328:Adult; D000465:Algorithms; D005150:Facial Hemiatrophy / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D012828:Silicones; D013524:Surgical Flaps; D013536:Suture Techniques; D013997:Time Factors
D012828:Silicones