Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical Management of Localized Scleroderma

  • Lee, Jae Hyun (Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine) ;
  • Lim, Soo Yeon (Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine) ;
  • Lee, Jang Hyun (Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Ahn, Hee Chang (Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine)
  • Received : 2017.08.16
  • Accepted : 2017.09.08
  • Published : 2017.09.20
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Localized scleroderma is characterized by a thickening of the skin from excessive collagen deposits. It is not a fatal disease, but quality of life can be adversely affected due to changes in skin appearance, joint contractures, and, rarely, serious deformities of the face and extremities. We present six cases of localized scleroderma in face from our surgical practice. Methods: We reviewed six localized scleroderma cases that were initially treated with medication and then received follow-up surgery between April 2003 and February 2015. Six patients had facial lesions. These cases presented with linear dermal sclerosis on the forehead, oval subcutaneous and dermal depression in the cheek. Results: En coup de sabre (n=4), and oval-shaped lesion of the face (n=2) were successfully treated. Surgical methods included resection with or without Z-plasty (n=3), fat graft (n=1), dermofat graft (n=1), and adipofascial free flap (n=1). Deformities of the affected parts were surgically corrected without reoccurrence. Conclusion: We retrospectively reviewed six cases of localized scleroderma that were successfully treated with surgery. And we propose an algorithm for selecting the best surgical approach for individual localized scleroderma cases. Although our cases were limited in number and long-term follow-up will be necessary, we suggest that surgical management should be considered as an option for treating scleroderma patients.

Keywords

References

  1. Saxton-Daniels S, Jacobe HT. Chapter 64: morphea. In: Fitzpatrick TB, Wolff K, editors. Fitzpatrick's: dermatology in general medicine. New York: McGraw-Hill Medical; 2012. p.692-701.
  2. Careta MF, Romiti R. Localized scleroderma: clinical spectrum and therapeutic update. An Bras Dermatol 2015;90:62-73.
  3. Kreuter A, Krieg T, Worm M, Wenzel J, Moinzadeh P, Kuhn A, et al. German guidelines for the diagnosis and therapy of localized scleroderma. J Dtsch Dermatol Ges 2016;14:199-216.
  4. Noh JW, Kim J, Kim JW. Localized scleroderma: a clinical study at a single center in Korea. Int J Rheum Dis 2013;16:437-41.
  5. Cho HK, Chun SI. A clinical study of localized scleroderma. Korean J Dermatol 1996;34:109-15.
  6. Eun C, Lee CW. A clinical study of localized scleroderma in childhood. Korean J Dermatol 1997;35:877-82.
  7. Sivek R, Emer J. Use of a blunt-tipped microcannula for soft tissue filler injection in the treatment of linear scleroderma (en coup de sabre). Dermatol Surg 2014;40:1439-41.
  8. Franco JP, Serra MS, Lima RB, D’Acri AM, Martins CJ. Scleroderma en coup de sabre treated with polymethylmethacrylate: case report. An Bras Dermatol 2016;91:209-11.
  9. Robitschek J, Wang D, Hall D. Treatment of linear scleroderma "en coup de sabre" with AlloDerm tissue matrix. Otolaryngol Head Neck Surg 2008;138:540-1.
  10. Hwang DY, Paik HW, Byeon JH. Correction of facial linear scleroderma 'coup de sabre' with BoneSource. J Plast Reconstr Aesthet Surg 2009;62:e25-8.
  11. Dai Y, Xu AE, He J. A case report of coup de sabre patient with hair transplantation. J Dermatolog Treat 2017:1-6.
  12. Park SW, Wang HY. Survival of grafts in coup de sabre. Dermatol Surg 2002;28:763-6.
  13. Ibler KS, Gramkow C, Siemssen PA. Autologous fat transplantation for the treatment of linear scleroderma en coup de sabre. Skinmed 2015;13:74-6.
  14. Karaaltin MV, Akpinar AC, Baghaki S, Akpinar F. Treatment of "en coup de sabre" deformity with adipose-derived regenerative cell-enriched fat graft. J Craniofac Surg 2012;23:e103-5.
  15. Oh CK, Lee J, Jang BS, Kang YS, Bae YC, Kwon KS, et al. Treatment of atrophies secondary to trilinear scleroderma en coup de sabre by autologous tissue cocktail injection. Dermatol Surg 2003;29:1073-5.
  16. Barin EZ, Cinal H, Cakmak MA, Tan O. Treatment of linear scleroderma (en coup de sabre) with dermal fat grafting. J Cutan Med Surg 2016;20:269-71.
  17. Kim JH, Lee SC, Kim CH, Kim BJ. Facial asymmetry: a case report of localized linear scleroderma patient with muscular strain and spasm. Maxillofac Plast Reconstr Surg 2015;37:29.

Cited by

  1. Overview of Juvenile localized scleroderma and its management vol.16, pp.1, 2020, https://doi.org/10.1007/s12519-019-00320-9
  2. Treatment of linear scleroderma “En coup de Sabre” with single‐stage autologous fat grafting: A case report and review of the literature vol.20, pp.1, 2021, https://doi.org/10.1111/jocd.13490
  3. A pilot study on ex vivo expanded autologous adipose‐derived stem cells of improving fat retention in localized scleroderma patients vol.10, pp.8, 2021, https://doi.org/10.1002/sctm.20-0419
  4. Aesthetic and therapeutic outcome of fat grafting for localized Scleroderma treatment: From basic study to clinical application vol.20, pp.9, 2017, https://doi.org/10.1111/jocd.13941