Deep inferior epigastric perforator dermal-fat or adiposal flap for correction of craniofacial contour deformities

Craniofacial contour deformities are difficult to reconstruct. This article summarizes the authors' use of deep inferior epigastric perforator dermal- fat or adiposal flaps in eight patients with such deformities. Of these pat ients, three had traumatic craniofacial or facial deformities, one had cong enital craniofacial deformity, two had hemifacial atrophy (one because of r adiation), one had hemifacial microsomia, and one had localized frontonasal lipodystrophy. Stable restoration of the facial contour was achieved in al l eight patients. The advantages of this flap are numerous. It has minimal donor-site morbidi ty, because the rectus abdominis muscle is preserved as a whole, and it acc ommodates pregnancy in female patients. Simultaneous elevation of this flap during preparation of the recipient site makes it possible to complete sur gery in a shorter time than with the scapular flap. Furthermore, a consider able amount of the superficial or deep fatty layer can be removed primarily , making a bulky flap into a thinner one. This flap also allows the use of a large transverse abdominal ellipse of skin, fat, and Scarpa's fascia with abdominoplasty closure. Conversely, it requires a technically difficult di ssection of the muscle perforator and skin grafting of donor defects in pat ients with a large dermal-fat flap. Also, additional minor operations may b e necessary to reduce fat volume around the perforator. Ultimately, the deep inferior epigastric perforator adiposal flap seems to be suitable for craniofacial contouring surgery. It is especially indicated for use in children and female patients who are expecting to have children .