DOI: 10.1097/PRS.0b013e3181706e2b

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PMID: 18520884

Issn Print: 0032-1052

Publication Date: 2008/06/01


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Correction of the Recalcitrant Posttraumatic Periorbital Soft-Tissue Deformity: A Novel Microsurgical Approach

Eduardo D. Rodriguez; Rachel Bluebond-Langner; Lara Devgan; Michael P. Grant; Nicholas Iliff; Paul N. Manson

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Excerpt

Remarkable advances have been made in the field of craniomaxillofacial trauma with regard to fixation of the skeleton by means of aesthetic incisions. Coronal, lower eyelid, and buccal sulcus approaches provide excellent exposure of the periorbital region but require wide subperiosteal undermining.1 Accurate soft-tissue replacement during the initial procedure is critical but continues to be a challenge and often requires secondary revisions.2 Although postoperative radiographs confirm ideal skeletal alignment, unrecognized soft-tissue malposition distorts the final result.
Posttraumatic facial contour abnormalities are related to volume loss from fat atrophy and soft-tissue descent, contraction, and adhesion. Fat grafting is valuable for treating small soft-tissue depressions and sulcus deformities; however, we have found it unpredictable for treating large posttraumatic defects. Soft-tissue rearrangement or volume replacement during secondary revisions becomes increasingly difficult and unpredictable following previous surgical interventions. The anatomical planes are less visible, poorly vascularized, and replaced by cicatricial fibrosis.3
The impact of the injury and multiple surgical procedures alter the periorbital envelope, resulting in lower eyelid malposition, increased scleral show, volume loss, and cheek ptosis.1 Aesthetic facial volume augmentation with microvascular flaps has been described.4–6 However, treatment of posttraumatic periorbital contour deformities with free tissue transfer has not been established. This article illustrates a novel approach for treating posttraumatic periorbital deformities that have failed corrective attempts with conventional techniques.
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