Grafting of autologous adipose tissue can be recommended in some cases of facial plastic surgery to correct the congenital and traumatic alterations. However, some authors have reported unpredictable results about both the resorption rate of adipose tissue grafts and the quantification of the consequent surgically increased volume loss [1, 2].
Besides, many authors have studied the behavior of adipose grafts in the areas treated with radiation therapy; these studies agree in considering these areas as being unsuitable for grafting of autologous adipose tissue [1, 2].
Rhabdomyosarcoma is a type of cancer that can also affect the orbit. It is not a common neoplasm and has an estimated annual incidence of approximately 4–5 new cases per million children below 15 years of age. There is a slight prevalence in males, with a male/female ratio of 1.5:1. Sarcomas of the soft tissues, the most frequent of which is rhabdomyosarcoma, represent 7% of all pediatric malignant tumors .
Although the 5-year survival rate of patients with orbital unilateral rhabdomyosarcoma is beyond 85%, the extent of eradication therapy and of the subsequent radiation therapy has a destructive impact on the treated area [4–6].
As a matter of fact, destructive surgery is not followed by rehabilitation. These patients often present with adipose tissue atrophy associated with deforming fibrotic conditions; these biological manifestations result from the radiations affecting that area [6, 7].
Enucleation of the eye, especially in small children, can cause atrophy of the corresponding hemiface and decreased orbital growth, which create reluctantly accepted aesthetic conditions .
The aim of this work is to describe a new surgical approach to atrophies in the zygomatic region of patients with previous oncological surgery and ocular radiation therapy: we discuss about a rationale for the use of dermal-fat grafts.
This is a new technique which has never been described before in the literature and it is innovative compared to the traditional techniques. This technique has the advantage of a natural final result; moreover, we can rule out any possibility of rejection. When we perform the surgery on irradiated tissues, which are therefore more vulnerable, we have the possibility of using autologous tissue causing no local reaction and providing an adequate tissue thickness.
This technique represents an excellent opportunity for treatment of this atrophies, but the only disadvantage is the need to remove tissue from a different region of the body.
The alternative surgical procedures may be the mobilization of closeness flaps, or the microsurgery or the lipofilling: the first could create more scarring, so it is not the most aesthetic alternative; the second is a much more invasive surgical technique and it has a duration longer operating with a poor predictability of results; in the third case, a good result requires more surgical sessions to achieve a stable result.