Esthetic restoration in progressive hemifacial atrophy (Romberg disease): structural fat grafting versus local/free flaps.
BACKGROUND
Progressive hemifacial atrophy, also called Parry-Romberg disease, is a craniofacial disorder that typically involves the subcutaneous layer of 1 side of the face. Autologous reconstruction is achieved through various techniques, including autologous grafting of fatty tissue, the use of pedicled flaps, and free tissue transfer based on microvascular anastomoses. Thus far, a systematic literature review devoted to compare different surgical techniques has not been published.


METHODS
The study selection process was adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were identified by performing a systematic search on Medline, Ovid, Embase, the Cochrane Database, Current Contents, PubMed, Google, and Google Scholar.


RESULTS
The initial search resulted in 871 articles through online access on July 2013. Sixty-six articles were included and fully reviewed for data extraction of the surgical procedures and divided into the following 4 groups: pedicled flaps, free flaps, structural fat grafting, and conjoint treatment (free flaps plus lipofilling).


CONCLUSIONS
The therapeutic management of progressive hemifacial atrophy is based on the severity of the disease. Except for minor degrees of atrophy, for which lipofilling can satisfy the requirements, vascularized fatty tissue is essential for long-term contour correction. Microsurgical transfer of buried flaps can be considered the most effective surgical treatment of middle and severe Romberg disease in long-term correction, complication rate, and reoperative rate.
From the *Maxillofacial Surgery and †Plastic and Reconstructive Surgery Units, Hospital of Florence, Florence, Italy.
Tommaso
T
Agostini
Giuseppe
G
Spinelli
Gaetano
G
Marino
Raffaella
R
Perello
D000273:Adipose Tissue / Q000637:transplantation*; D004954:Esthetics; D005150:Facial Hemiatrophy / Q000601:surgery*; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008866:Microsurgery; D013524:Surgical Flaps / Q000637:transplantation*