Vascularized Chin Fat Flap for Mandibular Reconstruction in Stable Scleroderma En Coup De Sabre: A Case Report and Review of Surgical Considerations

Scleroderma en coup de sabre (ECDS) is a rare form of linear scleroderma that typically causes progressive atrophy on the face, which can affect both appearance and function over time. Although various reconstructive strategies exist, the use of a vascularized chin fat flap (CFF) for mandibular soft tissue restoration has not been previously reported. We describe a 61-year-old woman with stable ECDS and anterior mandibular depression. After disease stabilization with methotrexate, a pedicled fat flap was harvested from the submental region and inset via a single incision while preserving its native vascular supply. At six months, the patient exhibited sustained volume, restored facial symmetry, excellent scar quality, and no complications. The CFF combines vascular reliability, anatomical compatibility, and minimal invasiveness. Its ability to achieve natural, long-lasting results in a single stage, potentially under local anesthesia, makes it a promising alternative to conventional methods such as fat grafting, fillers, or implants in ECDS-related facial atrophy.