Use of dermal-fat grafts in the post-oncological reconstructive surgery of atrophies in the zygomatic region: clinical evaluations in the patients undergone to previous radiation therapy

We report a case of a female patient with a medical history of surgical enucleation of the right eyeball, who had received rhabdomyosarcoma radiation therapy in her youth. The patient presented with a depression in the right zygomatic region. We took a dermal-fat flap from the abdominal region, which had been previously treated.The surgical outcome, 48 hours, and much clearly 31 days after the surgery, revealed that the right zygomatic region had returned to its proper anatomical shape, although there were still signs of postoperative edema.Very damaged tissues, like those exposed to radiation therapy, are generally not suitable for grafting of adipose tissue.In the described case, we achieved a technically and aesthetically satisfying result despite the patient's medical history involving several perplexities about the use of autologous dermal-fat tissues, because of prior radiation therapy exposure. The clinical case shows that even a region exposed to radiation therapy can be a valid receiving bed for dermal-fat grafting.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 pediatri