title: Use of various free flaps in progressive hemifacial atrophy.
abstract: OBJECTIVE
  Romberg disease is an uncommon condition manifested by progressive hemifacial atrophy of the skin, soft tissue, and bone. Facial asymmetry with soft tissue deficiency in Romberg disease causes a significant disability affecting the social life and can bring about many psychological problems.
  
  
  METHODS
  The aim of surgical treatment is cosmetic amelioration of the defect. Several conventional reconstructive procedures have been used for correcting facial asymmetry. They include fat injections, dermal fat grafts, filler injections, cartilage and bone grafts, and pedicled and free flaps. We report our experiences with 11 patients involving 11 free flaps with a minimum 1-year follow-up. All patients were classified as having moderate to severe atrophy. The average age at disease onset was 4.5 years; the average duration of atrophy was 5.2 years. No patients were operated on with a quiescent interval of less than 1 year. The average age at operation was 20.1 years, ranging from 10 to 55 years. Reconstruction was performed using 4 groin dermofat free flaps, 4 latissimus dorsi muscle free flaps, and 3 other perforator flaps. To achieve the finest symmetrical and aesthetic results, several ancillary procedures were performed in 4 patients. These procedures included Le Fort I leveling osteotomy, sagittal split ramus osteotomy, reduction malarplasty and angle plasty, rib and calvarial bone graft, correction of alopecia, and additional fat graft.
  
  
  RESULTS
  All patients were satisfied with the results.
  
  
  CONCLUSIONS
  We believe that a free flap transfer is the requisite treatment modality for severe degree of facial asymmetry in Romberg disease.
authors.affiliation: Department of Plastic and Reconstructive Surgery, School of Medicine, Seoul National University, Seoul National University Bundang Hospital, Seoul, South Korea.
authors.forename: Rongmin
authors.initials: R
authors.lastname: Baek
authors.forename: Chanyeong
authors.initials: C
authors.lastname: Heo
authors.forename: Baek-kyu
authors.initials: BK
authors.lastname: Kim
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D004954:Esthetics; D005150:Facial Hemiatrophy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019340:Osteotomy, Le Fort; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome