Prefabricated Superficial Temporal Fascia Flap Combined with a Submental Flap in Noma Surgery

Abstract

The authors report their experience with a new procedure: the combination of a prefabricated superficial temporal fascia flap and a submental flap performed in an African hospital on five patients with cheek deformities caused by noma. The prefabricated superficial temporal fascia flap makes the inner lining of the cheek, which is anchored on the peripheral scar tissue. The submental flap is released during the second operation and makes the outer lining. The main advantages are the excellent aesthetic color of this last flap and the short distance between the donor site and the recipient site. Moreover, the submental flap is positioned in a single operation (when the outer-lining reconstruction is performed with a deltopectoralis flap, a third operation is necessary to cut the pedicle). None of the flaps failed, and the functional results were good. The prefabricated superficial temporal fascia flap and submental flap are versatile and reliable flaps, with reasonably long vascular pedicles, that can be used successfully, even under suboptimal conditions in weak patients with huge defects of the face.

First Experiences with Simultaneous Skeletal and Soft Tissue Reconstruction of Noma-Related Facial Defects

“…Noma is primarily treated in the countries where the disease is endemic, where suboptimal medical circumstances are common, and mission time is limited. Local and regional flaps for a comprehensive, simultaneous soft and hard tissue reconstruction are very complicated and elaborate to create good results (Brigitte Pittet, personal communication and 13,15,23 ). It is a common myth that pedicled flap transfers in general are smaller procedures or are easier to teach.…”

“…All these patients were treated with the typical spectrum of local and regional soft tissue flaps according to the concepts of noma surgery well described in the pertinent literature. 5,10,12,[19][20][21][22][23] Over the years, we finally integrated microvascular options into our spectrum-even in suboptimal medical circumstances-with encouraging results for selected complex and huge defects. 7,16,18 The next logical step was the integration of viscerocranial bone reconstruction concepts for those cases.…”

Early outcome of facial reconstructive surgery abroad: a comparative study

“…This avoided the use of the deltopectoral flap, which carries a high morbidity especially in children. The submental flap has two advantages, it carries hardly any donor site morbidity and the graft colour is an excellent match for facial skin [9, 10]. However, the blood supply to the tip of the flap is a little precarious.…”

Colgajo submental para reconstrucción de defectos oncológicos en cabeza y cuello

“…The submental flap has shown is versatility in lesions of the inferior half of the case of trauma, tumors, burns, 2,7,8,13,14 and noma disease. 8,15 In order to improve the facial contour in hemi facial microsomia and facial paralysis (160, hard palate reconstruction and buccal floor lesions, 6,10,18,19 Kim et al 4 used a submental flap of inversed flow to reconstruct the nose. Pistre et al 8 used it as a compound flap and incorporated mandible bone.…”