A Soft Tissue Approach to Treacher Collins Reconstruction

Treacher Collins syndrome is an autosomal dominant mandibulofacial dysostosis with characteristic hard and soft-tissue facial abnormalities. These include ocular malformations, ear malformations, and hypoplasia of the facial skeleton, especially of the malar bones and mandible. Traditionally, surgical correction of the facial abnormalities has focused on skeletal reconstruction to restore facial form and symmetry. In this report, the authors described the use of customized parascapular free flaps, after craniofacial surgery, for the correction of defects of facial contour in Treacher Collins patients.

From June 1995 to December 2003, 8 patients with Treacher Collins syndrome underwent microsurgical correction of facial contour using 12 free flaps. In all patients, staged parascapular free flaps were used for reconstruction. The microvascular technique involved a two-team approach with simultaneous ipsilateral parascapular flap harvest and facial pocket dissection. The flaps were contoured, revascularized (10 superficial temporal vessels, 2 facial vessels), and inset. No vein grafts were used. The patients were followed for a minimum of 1 year and postoperative evaluation included aesthetic photography, visual assessment, and subjective evaluation by the patient and family.

Eight patients had previous facial skeleton correction using craniofacial techniques. The ages at operation ranged from 4 to 19 years. Twelve parascapular free flaps were used in the 8 patients. Postoperative complications were limited to one hematoma. There were no partial or total flap losses. All the patients had improved facial contour and symmetry. Overlying skin tone and color similarly improved.

After traditional skeletal reconstruction for the complex craniofacial defects of Treacher Collins syndrome, deficiencies in facial contour and symmetry usually persist. Customized soft-tissue free flaps can be employed to differentially resurface these defects and achieve optimal aesthetic results in these challenging patients.