RESUMEN
Romberg's disease is a rare condition characterized by progressive hemifacial atrophy. The atrophic process typically has its onset in the first or second decade of life, it continues for a few years (usually 2, but up to 10), and then it stops spontaneously. The subcutaneous tissue is the first to be involved by the disease, followed by muscles, bones, and, rarely, the skin. The etiology of the disease is unknown. The only available treatment is surgical. Several techniques have been reported in the literature, from fat transplant, to silicon prostheses, to the use of flaps. We present our experience in successfully treating six patients (3 males and 3 females) affected by Romberg's hemifacial atrophy of intermediate or severe degree. A technique including a free parascapular microvascular flap with the adjunct of porous polyethylene implants was used. Further correction was performed with remodeling or resuspension.
Asunto(s)
Hemiatrofia Facial/cirugía , Prótesis Maxilofacial , Colgajos Quirúrgicos , Tejido Adiposo/trasplante , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Prótesis Maxilofacial/efectos adversos , Fístula Oral/etiología , Polietilenos , Escápula , Trasplante de PielRESUMEN
The radial forearm free flap (RFFF) is one of the most widely used and versatile fasciocutaneous free flaps in head and neck reconstruction because of its qualities--the consistent vascular anatomy; the thin and pliable nature; the minimal hair presence; and the possibility of harvesting and transferring it as a composite tissue flap, with bone, tendon, and nerve. The RFFF provides a method of single-stage reconstruction of wide residual defects after excision of advanced cancer (T3-T4) in the head and neck region. We present our ten-year experience with RFFF and the good results obtained with some refinements, which allowed us to verify the efficacy of the oral competence using the palmaris gracilis tendon as a sling. We also present the possibility of harvesting long segments of radius (up to 18 cm), and the discovery that use of antithrombotic or anticoagulant therapy is not necessary for the flap survival. This treatment does not guarantee a complete recovery, but it can improve the quality of the patient's life.