ofPlastic Surgery (1977), 30, 14-16

British _%foernal

A FREE GROIN FLAP RECONSTRUCTION IN PROGRESSIVE

FACIAL HEMIATROPHY

By TAKAOHARASHINA,
M.D., TATSUONAKAJIMA,M.D. and YOKOYOSHIMURA,
M.D.
Department of Plastic and Reconstructive Surgery, Keio University Hospital,
35 Shinanomachi Shinjukuku, Tokyo, Japan 160

THE treatment of progressive facial hemiatrophy (Rombergs disease) has long been
unsatisfactory; bulky free grafts take badly while pedicled flaps are time consuming
and scar producing. Tissue transfer by microvascular anastomoses would seem to
offer greater possibilities of success and already Fujino et al. (1975) have used a free
deltopectoral flap and Dr Seiichi Ohmori (personal communication) has used omentum
to replace the lost subcutaneous tissue. But the former leaves unacceptable scars on
a woman and the latter involves opening the abdomen. In the case presented we decided

Fig. I. Facial herniatrophy in a z8-year-old woman.

FIG. 2. The dotted line is the proposed incision, the solid lines the extent of the undermining. The
arrows indicate the position of the facial vessels.
14
 FREE GROIN FLAP RECONSTRUCTION IN PROGRESSIVE FACIAL HEMIATROPHY 15

FIG. 3. Immediately after the groin flap had been sutured in place.

FIG. 4. The flap survived completely and the deformity has been over-corrected.

FIG. 5. Two months after the second operation when the remaining groin skin and excess fat had been
removed.
16 BRITISH JOURNAL OF PLASTIC SURGERY
to use a free groin flap to avoid these problems. For reasons which will be discussed
later, a z-stage procedure was planned.

CASE REPORT
A z&year-old woman first noticed the progressive atrophy of the left side of her face when
she was 24. She had been referred to us 18 months previously but the disease was still pro-
gressing and operation was postponed until the condition seemed stable (Fig. I).
At operation the facial skin was raised over the depressed area through a long submandi-
bular incision and the facial artery and vein were dissected free (Fig. 2). A groin flap 6 x 18 cm
was raised and the nutrient vessels anastomosed to the facial vessels. The upper half of the
groin flap was denuded of its epidermis and placed subcutaneously; the skin covering the re-
mainder was sutured into the submandibular wound (Fig. 3). The bulk of the flap was such
that the deformity was over-corrected. The flap survived completely (Fig. 4).
The second operation was carried out when the oedema had subsided. The remaining
flap skin and the excess fat were resected (Fig. 5). The resected tissues were macroscopically
and histologically normal.

DISCUSSION
There are several advantages in making this a 2-stage procedure and-leaving part
of the flap skin in the submandibular wound at the first operation.
The flap may be readily monitored during its early postoperative course.
The facial skin in Rombergs disease is shrunken and, if the submandibular wound
were to be closed immediately over the bulky flap, the increased skin tension might
well kill the flap.
A planned second stage enables the defect to be over-corrected at the first stage
and the excess fat removed when the size and shape have become stable.
It is dangerous to trim fat from a free flap primarily.
In extreme cases of facial skin deficiency some of the groin flap skin might be
retained at the second stage, but in this patient and probably in most, the colour match
was unsatisfactory.

REFERENCE
FUJINO, T., TANINO, R. and SUGIMOTO,C. (1975). Microvascular transfer of free delto-
pectoral dermal-fat flap. Plastic and Reconstructive Surgery, 55, 428.