Approach to Fronto-orbital Sequelae in Anterior Synostotic Plagiocephaly: Our Severity-Based Flow Chart

Reconstruction with microvascular free flaps is the most widespread method currently employed in case of extensive defects after resection of head and neck cancer. Unfortunately, in those patients where a flap failure is reported, due to local complications such as inflammation, infection, or radiotherapy (RT) sequelae, the soft tissues surrounding the flap are often hypotrophic, scarred, or contracted. In order to achieve an acceptable result at the end of the reconstruction process, we introduced an intermediate step in the treatment of these patients which consists of lipofilling of the treated area. This procedure enables repair and augmentation of soft tissues and is increasingly used both in esthetic and reconstructive surgery. A custom titanium plate was then made using a computer-aided manufacturing/computer-aided modeling (CAD/CAM) technique and placed after lipofilling procedure. Fat tissue was harvested from the abdomen or inner side of the knees based on the patient physical constitution. Photographs took after the first step and the final ones were compared by the patients and their families during check-ups. Both patient and surgeon were satisfied with the esthetic outcome. The reconstruction stage is as important as ablative surgery, it is a psychologically important step in the patient’s therapeutic path, they begin to see beyond the disease, and thinking about esthetic rehabilitation gives them strong motivations