The use of microvascular free flaps for soft tissue augmentation of the face in children with hemifacial microsomia

The extent of facial deformity from hemifacial microsomia varies considerably. Minor degrees of asymmetry may be barely perceptible. Severe defects involve deficiencies and asymmetry of bone and soft tissue. Hence, reconstruction of both soft and hard tissues may be necessary. The authors have utilized a free flap based on the superior gluteal vessels to replace soft tissue deficits in 3 children with hemifacial microsomia. The flap, composed of fascia lata, adjacent muscle and fat (2 patients) and overlying skin (1 patient), is harvested through an incision high on the lateral thigh in the 'bathing trunk' area. The vessels, measuring 0.5-1.0 mm were anastomosed to the facial (1 patient) and superficial temporal (2 patients) vessels. In 1 child, simultaneous mandibular restructuring was done with bone grafts. The children ranged in age from 4 to 8 yr. Follow-up is for 5 to 7 mth. Although this microvascular procedure requires a prolonged anesthetic, it permits more accurate and predictable reconstruction. Scars are placed in inconspicuous or concealed areas. Simultaneous bony reconstruction can be done. Details of the procedure and an evaluation of postoperative results are presented.