Abstract:Noma victims suffer from a three-dimensional facial soft-tissue loss. Some may also develop complex viscerocranial defects, due to acute osteitis, chronic exposure, or arrested skeletal growth. Reconstruction has mainly focused on soft tissue so far, whereas skeletal restoration was mostly avoided. After successful microvascular soft tissue free flap reconstruction, we now included skeletal restoration and mandibular ankylosis release into the initial step of complex noma surgery. One free rib graft and parasc… Show more
“…We found that the same team would often visit the same site repeatedly and perhaps more importantly, unlike the microsurgical services offered by local surgeons, nearly all of which were performed in major cities, visiting teams concentrated their work in much smaller and much poorer rural areas such as in Sokoto, Nigeria (Noma Children's hospital) and in Malindi, Kenya (Tawfik Hospital and Malindi District Hospital), all of which are located over 700km away from the commercial capital. 5,11,[53][54][55][56][57][58][59][60][61] The study also revealed significant differences in patient selection and flaps performed by visiting surgeons compared to local teams. Noma reconstruction was the primary focus of surgical missions with visiting surgeons performing 94.3% of all noma microsurgical reconstruction in the entire period studied from 1976-2020.…”
“…We found that the same team would often visit the same site repeatedly and perhaps more importantly, unlike the microsurgical services offered by local surgeons, nearly all of which were performed in major cities, visiting teams concentrated their work in much smaller and much poorer rural areas such as in Sokoto, Nigeria (Noma Children's hospital) and in Malindi, Kenya (Tawfik Hospital and Malindi District Hospital), all of which are located over 700km away from the commercial capital. 5,11,[53][54][55][56][57][58][59][60][61] The study also revealed significant differences in patient selection and flaps performed by visiting surgeons compared to local teams. Noma reconstruction was the primary focus of surgical missions with visiting surgeons performing 94.3% of all noma microsurgical reconstruction in the entire period studied from 1976-2020.…”
“…6 a–d, necrosis). Often, the necrosis leads to bilateral constriction of temporomandibular joints during the healing period [ 26 ]. Eighty percent of infected children still die because no antibiotics are available.…”
Section: Discussionmentioning
confidence: 99%
“…b The sequelae required multistage reconstruction of bone, soft tissue, and skin. c A free osteocutaneous parascapular flap reconstructed the maxilla (OP Goetz Giessler) [ 26 , 27 ]. d A three-layer nasal reconstruction with a pre-expanded forehead flap and airway opening perfected the reconstruction Fig.…”
Background
INTERPLAST, Inc. was founded in 1969 by plastic surgeons in Stanford, CA, to create a financial basis through donations to operate foreign patients at Stanford or send surgical teams to developing countries. With the same financial effort, 50 to 100 times more patients can be operated on locally than in a hospital at home. Stanford’s example was appealing to many plastic surgeons worldwide, who founded similar INTERPLAST NGOs in their own countries.
Methods
A literature review revealed worldwide humanitarian actions of INTERPLAST teams, whose annual effectiveness is comparable to the operation numbers of large plastic surgery departments. Six patients with complex facial deformities requiring multiple surgical interventions were selected for temporary stay and operations in Germany.
Results
Repeated missions at the same hospitals with training of local surgeons have increased significantly compared to earlier “parachute missions.” Microsurgical procedures for free flaps with magnifying glasses are now possible for the experienced even in hospitals in developing countries. The most efficient medical aid in the future will be the expansion and establishment of departments or hospitals in developing countries supported or maintained by partner hospitals in our home country.
Conclusions
Operations of humanitarian plastic surgeons in developing countries are becoming increasingly difficult. Local health authorities require temporary surgical permits, customs offices try to clear surgical material and look at expiration dates of medicines, and pandemics complicate planning of INTERPLAST missions. It therefore seems increasingly necessary to go as single teacher, training engaged local surgeons and assisting operations. The alternative is inviting local surgeons to Western hospitals and introducing them to the basic skills of plastic surgery and empathy with the poor. However, the lack of recognition of medical degrees from all developing countries remains a problem for their training in Europe.
Level of evidence: Level V, risk/prognostic
“…4 Noma can cause extensive soft tissue losses and trismus; excision of fibrosis and flap replacement are combined with a graded approach to maximize mouth opening, setting the basis for rational application of postoperative physiotherapy. 5 Trismus also may result from soft tissue fibrosis following radiation in head and neck malignancies; the associated chronic radiation dermatitis causes risk of developing skin necrosis, when surgical intervention is needed for restoration of mouth opening. Any of the conditions described above may present a "double trouble" of facial skin loss, real or apparent (following radiotherapy), and trismus.…”
Section: Introductionmentioning
confidence: 99%
“…Noma can cause extensive soft tissue losses and trismus; excision of fibrosis and flap replacement are combined with a graded approach to maximize mouth opening, setting the basis for rational application of postoperative physiotherapy. 5 …”
A case series of five patients with skin loss in the lateral face with trismus that followed delayed presentation following trauma, necrotizing infection, and radiation fibrosis was treated with coronoidectomy and condylar excision to effect adequate mouth opening; the anterolateral thigh flap was used for cover and the fascia was used as an interposition graft to prevent recurrence. Two patients with more than 9 years of follow-up had an average of 40 mm interincisal opening.
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