Visor flap for total upper and lower lip reconstruction: a case report

Abstract

IntroductionNoma, aptly named the 'face of poverty', is a scourge with a mortality rate of up to 90% that affects some 140,000 people each year, predominantly children in the sub-Saharan 'noma belt'. Survivors of the acute attack suffer severe facial disfigurement from loss of facial tissue and scarring. Surgical reconstruction of noma defects is a major challenge, especially in Africa, where the majority of cases occur.Case presentationWe report the case of a 40-year-old Somali man who presented with severe facial disfigurement, including total absence of both upper and lower lips. After a failed initial reconstruction, a combination of platysma flaps and a left deltopectoral flap provided mucosal lining, while a scalp visor flap served to recreate upper and lower lips, the beard and moustache.ConclusionThe scalp visor flap offers a simple but extremely versatile tool for use in midfacial reconstruction, especially in the male, providing neo-lip tissue, a moustache and a beard. This is the first report of a simultaneous total upper and lower lip reconstruction using a scalp visor flap, in the English literature. We also emphasize on a process of transfer of skills to enable local surgeons to effectively manage the challenge that noma presents.

Reconstruction of the complete loss of upper and lower lips with a chimeric anterolateral thigh flap: A case report

“…However, sacrifice of one major artery of the hand, numbness, and two obvious donor-site scars are the major disadvantages. Nthumba et al 4 have reported that a scalp visor flap can be applied to total lip defects. Its advantage is that it has an excellent blood supply via its double pedicle with two superficial temporal arteries.…”

“…There are few reports of reconstructing complete lip defects in the literature. 4,7,8 For repairing partial lip defects, a free RFA flap 5,6,9 has been the most frequently reported. It has the advantage of a good blood supply, but only a straight axial vessel is acquirable, which does not provide adequate coverage of the upper and lower lips.…”

“…The oral cavity is the most common site of this tumor, and wide excision is the most commonly used treatment. 1 To restore the lips, free-tissue transfer is the first choice of reconstruction after cancer resection in the head and neck area, 2 and several kinds of reconstructive options have been proposed, including chimeric anterolateral thigh (ALT) flaps, 3 scalp visor flaps, 4 and free radial forearm (RFA) flaps. [5][6][7][8][9] We chose one free ALT flap in chimeric style for reconstruction with two skin islands, each with its independent perforator.…”

Total Lower Lip Reconstruction with Innervated Radial Forearm Flap and Palmaris Longus Tendon

“…A multitude of local or pedicled flaps have been described to reconstruct total lip defects where free flaps are not an option but usually lack functionality or provide insufficient soft tissue, especially in younger patients with lack of skin laxity. The double mental neurovascular V-Y island advancement flap (Chen et al 2012;Fang et al 2014), the extended Karapandzic flap (Dediol et al 2018), the visor flap (Nthumba and Carter 2009), and the modified bilateral cheek flap (Chowchuen 2016) have been described and achieved good results, even though usually reserved for older patients after cancer resections, with more skin laxity. Furthermore, neck flaps can be used as salvage procedure in very sick or old patients who do not qualify for free tissue transfer or after failed free flap reconstruction (Yildirim et al 2010).…”

HIV Infection: Implications on Surgical Practice

“…Cancrum oris is a disease that afflicts children, associated with poverty, malnutrition, poor oral hygiene and infectious disease; in adults, it has been associated with debilitating diseases such as HIV/AIDS, diabetes mellitus and hematological disorders. (Nthumba & Carter, 2009). With the advent of HIV/AIDS, noma appears to be on the increase: successful surgical reconstruction with minimal complications has been reported (Chidzonga & Mahomya, 2008).…”