Experience with the free "inverted" groin flap in facial soft tissue contouring; a report on 6 flaps.

Reconstruction of the soft tissue facial contour defect in Romberg's disease and facial lipodystrophy using a free groin flap has been previously reported. However, controversy exists over the optimum placing of this flap within the cheek, i.e. whether it is better to have the dermis or subcutaneous fat side next to the muscle. Our experience with 6 flaps, 3 of which have been followed up for 3 1/2 years, is presented. In all cases the flaps were placed with the dermis side down, i.e. next to muscle. Although not a comparative study, our impression is that in the long term this technique reduces gravitational migration. Our experience with 2 flaps suggests that, in the early postoperative period at least, secure fixation by suturing to the muscle and periosteum is important. We believe that, in addition, this method gives a smoother contour and allows easy and safe secondary adjustments to be made where necessary.