From the Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health.
Plast Reconstr Surg. 2020 Feb;145(2):483-492. doi: 10.1097/PRS.0000000000006511.
Hemifacial atrophy (Parry-Romberg syndrome) is an enigmatic craniofacial disorder characterized by progressive facial atrophy. Early age at onset is associated with significant skeletal involvement and jaw abnormalities. Standard reconstructive dogma dictates that the disease should "burn out," with at least 2 years of no disease progression, before pursuing reconstructive intervention. The purpose of this article is to present the senior author's (J.W.S.) experience treating preadolescent children with free soft-tissue transfer for reconstruction of progressing hemifacial atrophy, and to review surgical techniques in this patient population.
Pediatric free tissue transfer cases performed by the senior author were reviewed. Free tissue transfer using a circumflex scapular adipofasciocutaneous flap was performed to treat deformities arising from hemifacial atrophy.
Thirty-six patients aged 3 to 6 years underwent free tissue transfer in the presence of progressing, active disease. Follow-up ranged from 7 months to 25 years. There were no cases of flap loss. In all patients, the disease process seemed to be altered, with no symptoms recurring to date.
The authors believe that early microsurgical correction of hemifacial atrophy in children as young as 3 years is reliable and effective. The authors theorize that the interposition of vascularized, healthy tissue may alter or even halt the progression of disease, and may also prevent the skeletal hypoplasia classically seen in older patients. Further study incorporating autologous fat grafting as a control procedure may provide additional insight into this challenging disease process.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
半侧颜面萎缩症（Parry-Romberg 综合征）是一种以进行性面部萎缩为特征的神秘颅面疾病。发病年龄较早与明显的骨骼受累和颌骨异常有关。标准重建学说认为，在进行重建干预之前，疾病应该“消退”，至少 2 年没有疾病进展。本文的目的是介绍资深作者（J.W.S.）治疗进展性半侧颜面萎缩的青少年儿童的经验，并回顾该患者群体的手术技术。
回顾资深作者进行的小儿游离组织转移病例。使用旋肩胛动脉皮瓣游离组织转移来治疗因半侧颜面萎缩引起的畸形。
36 例年龄 3 至 6 岁的患者在进展性、活动性疾病存在的情况下接受了游离组织转移。随访时间从 7 个月到 25 年不等。没有皮瓣坏死的病例。在所有患者中，疾病过程似乎都发生了改变，迄今为止没有症状再次出现。
作者认为，在儿童期早期进行半侧颜面萎缩的显微外科矫正既可靠又有效。作者推测，血管化的健康组织的介入可能会改变甚至停止疾病的进展，并且还可能防止在老年患者中常见的骨骼发育不良。进一步的研究纳入自体脂肪移植作为对照程序可能会为这一具有挑战性的疾病过程提供更多的见解。
临床问题/证据水平：治疗性，IV。
