ABSTRACT
We describe our experience with perforator-based anterolateral thigh (ALT) flaps for
facial contour augmentations in a standardized two-step procedure. In a series of
eight consecutive patients (two men, six women) suffering from contour deformities
due to different reasons (scleroderma: three, Parry-Romberg syndrome: three, trauma:
one, tumor: one), soft tissue augmentations were performed via a preauricular approach.
Flaps were harvested from the ALT as perforator-based dermofat (two) or adipofascial
flaps (six) with only a small sheet of fascia and a minimal cuff of muscle around
the perforators. All flaps were anastomosed to the superficial temporal vessels. For
refinement of the primary result, excess volume was removed and minor contour irregularities
were smoothed out after 6 months. Despite the small-vessel caliber, anastomoses caused
no problems, and all flaps healed well. Because defects were located close to the
temporal vessels, the length of the perforator pedicle was always sufficient. Facial
contour could further be improved after secondary reshaping of the healed flaps. This
led to nearly perfect long-term facial symmetry in all cases. The ALT proved to be
a reliable donor site, providing enough well-vascularized fatty tissue for facial
contour augmentation in normal-weight patients. No submandibular incision is necessary
if the perforators are anastomosed to the superficial temporal vessels. The preauricular
incision gives an excellent view to the operating field.
KEYWORDS
ALT flap - soft tissue augmentation - adipofascial flaps
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Prof. Klaus WolffM.D. D.M.D. Ph.D.
Klaus In der Schornau 23-25 Bochum 44892
Germany