Sinclair Nicholas, Gharb Bahar Bassiri, Papay Francis, Rampazzo Antonio
Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH.
J Craniofac Surg. 2019 May/Jun;30(3):879-887. doi: 10.1097/SCS.0000000000005320.
Hemifacial microsomia is the most common congenital disorder of the face after cleft lip and palate. While treatment of the bony abnormalities has been well documented, less attention has been paid to correction of the soft tissue deformity. This study aimed to systematically review the literature addressing the techniques utilized to correct the soft tissue deformity in hemifacial microsomia.
A comprehensive review of peer-reviewed literature regarding the management of soft tissue reconstruction in patients with hemifacial microsomia was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Odds ratio was used to assess differences in complication rates between reconstructions performed with free tissue transfer and fat grafting.
The literature search yielded 38 articles that were fully reviewed for data extraction. Articles were grouped into one of 5 reconstructive modalities-pedicled flap, microvascular free tissue transfer, structural fat grafting, alloplastic implant, and functional reconstruction. Microvascular free tissue transfer had a complication rate of 27.1%, while structural fat grafting had a complication rate of 4.2% (odds ratio 6.7, P = 0.0003).
Microvascular free tissue transfer likely provides greater volume than fat grafting at the cost of a higher complication rate. Mild to moderate soft tissue deformity can be corrected with serial fat grafting. However, severe soft tissue deformity is better corrected with microvascular free tissue transfer. When performing free tissue transfer, one should be prepared for recipient vessel anomalies. To provide adequate augmentation with isolated fat grafting, multiple sessions are likely required.
半侧颜面短小畸形是唇腭裂之后最常见的先天性面部疾病。虽然骨骼异常的治疗已有充分文献记载，但对软组织畸形矫正的关注较少。本研究旨在系统回顾关于矫正半侧颜面短小畸形软组织畸形所采用技术的文献。
根据系统评价和Meta分析的首选报告项目声明，对关于半侧颜面短小畸形患者软组织重建管理的同行评审文献进行了全面回顾。采用优势比评估游离组织移植和脂肪移植重建之间并发症发生率的差异。
文献检索得到38篇文章，对其进行了全面审查以提取数据。文章被分为5种重建方式之一——带蒂皮瓣、微血管游离组织移植、结构性脂肪移植、异体植入物和功能性重建。微血管游离组织移植的并发症发生率为27.1%，而结构性脂肪移植的并发症发生率为4.2%（优势比6.7，P = 0.0003）。
微血管游离组织移植可能比脂肪移植提供更大的组织量，但并发症发生率较高。轻至中度软组织畸形可用系列脂肪移植矫正。然而，严重软组织畸形用微血管游离组织移植矫正效果更佳。进行游离组织移植时，应做好应对受区血管异常的准备。为通过单纯脂肪移植提供足够的组织增量，可能需要多次手术。
