The use of free revascularized grafts in the amelioration of hemifacial atrophy.

Nine female and three male patients, 5 to 47 years old, were treated by free revascularized grafts for Romberg's disease. Greater omentum was transferred in nine, de-epithelialized skin flaps in three. Follow-up ranges from several months to 7 years. Microvascular failures or donor site complications did not occur. To further trim transferred tissue, overcome gravitational sag, or both, all but one patient required a secondary procedure. The only facial complication included partial loss of the transferred omentum and spotty necrosis of the overlying skin. The choice of omentum or de-epithelialized skin and subcutaneous fat is dictated by the extent of the facial defect. Generalized defects are corrected with omentum and localized segmental defects with de-epithelialized flaps. Because of observed late complications, including chronic inflammation, induration, and sinus tracts, we no longer recommend medical-grade liquid silicone as a therapeutic option in the palliation of Romberg's disease.