New and Successful Technique for the Management of Parry-Romberg Syndrome's Soft Tissue Atrophy.
Parry-Romberg syndrome (PRS) is an infrequent, acquired disorder characterized by progressive hemiatrophy of the skin and soft tissue of the face and, in some patients, results in atrophy of muscles, cartilage, and the underlying bony structures.The disease process exhibits varying speeds of development, with onset occurring in early infancy or adolescence. Clinicians have classically reserved treatment until the end of the process. Various treatment modalities have been attempted with differing results. Described treatments include free tissue transfer (omentum, rectus, latissimus, serratus, diep, scapula, and parascapular), pedicled flaps, autologous tissue (dermis-fat, bone and cartilage, and fat), and biomaterials (silicone, polyethylene, and Alloderm).In this article, the authors present a patient of Parry-Romberg syndrome in a young boy who had undergone a free flap previously, which failed to fill the atrophy of the right hemifacial soft tissues. The authors used Integra, which is a bilayer porous matrix of cross-linked bovine tendon collagen and glycosaminoglycan, and a semipermeable polysiloxane (silicone layer) and fat grafts enriched with Harvest PRP, to produce volume and symmetric contour on the affected side. The patient had a follow up of 2 years with excellent esthetic and functional results.


OBJECTIVE
The authors present a technique of volume replacement in patients with hemifacial atrophy because of Parry-Romberg syndrome, which has never been reported before in the international literature.


METHODS
Microsurgical reconstruction is considered the gold standard to restore facial symmetry. Given a free flap morbidity and risk of complications, some patients opt for less extensive procedures. The authors present the case of a 12-year-old boy with a history of Parry-Romberg syndrome with resultant right hemifacial atrophy. Consistent with the usual pattern of atrophy, the onset of the patient's disease began at the age of 5 years.


METHODS
The senior authors used a combination of a stacked Integra cheek implant and fat grafts enriched with Harvest PRP to produce volume and symmetric contour on the affected side. The patient was discharged home the next day after the surgical procedure from the recovery room, without complications.


RESULTS
The patient was followed for 2 years. He has had no complications and maintains an excellent symmetric result. The patient is highly satisfied with his result and has not required any further surgery. Preoperative and postoperative photos at year of follow up are presented.


CONCLUSIONS
Less invasive treatment options exist for hemifacial atrophy from Parry-Romberg syndrome.
*Plastic and Reconstructive Surgery Department of the Hospital Simón Bolivar and La Fundación Santa Fé de Bogotá and Hospital de la Policia †Plastic and Reconstructive Surgery Department of the Hospital Simón Bolivar, Bogota, Columbia.
Viviana Gómez
VG
Ortega
Daniel
D
Sastoque
D000273:Adipose Tissue / Q000637:transplantation*; D002648:Child; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D004954:Esthetics; D005145:Face / Q000601:surgery*; D005150:Facial Hemiatrophy / Q000601:surgery*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation; D017060:Patient Satisfaction; D053657:Platelet-Rich Plasma / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D015361:Rhytidoplasty / Q000379:methods; D017768:Skin, Artificial
C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen