306 Outcomes of surgical correction of facial morphea: A cross-sectional analysis

Abstract

Surgical procedures are often recommended for morphea, but their timing is controversial. A cohort of 17 patients who underwent 43 procedures were followed for 1-60 months. These patients had mostly facial linear morphea (94%). The most common procedure was fat grafting for facial morphea (67%, n=29), but others included free tissue transfer (7%) and filler injections (7%). Recurrent disease, as determined via clinical examination and/or imaging using validated measures, was noted 8-36 months post-procedure in 3 patients after free tissue transplant, 2 after fat transfer, and 1 after osteoplasty. Patients with disease recurrence were less likely to be following with a dermatologist prior to procedure when compared to patients without (50% vs 100%, p=0.004), and were less likely to have a preceding MRI to assess activity (25% vs 78%, p=0.04). We highlight in particular cases of recurrence after free tissue transfer, as recent studies suggest this to be therapy for active disease. One patient underwent parascapular flap transfer shortly after diagnosis of Parry Romberg Syndrome (PRS) at age 18. He never underwent medical therapy, and experienced recurrence shortly after the procedure. Ultimately, his facial asymmetry improved with immunotherapy and fat transfer. The other two patients underwent microvascular free flap transplant at ages 9 and 16, within 1 year of PRS diagnosis. They experienced recurrence within 1 year, likely due to inadequately treated disease activity at time of procedure. While free tissue transfer and other procedures can be appropriate treatments for the cosmetic and functional impact of morphea, these are not definitive therapy for active disease. Results of this small study indicate the importance of a multi-disciplinary approach in ensuring morphea inactivity through both clinical evaluation and objective imaging measures prior to recommending surgical procedures.