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1.
Craniomaxillofac Trauma Reconstr ; 6(1): 61-4, 2013 Mar.
Article in English | MEDLINE | ID: mdl-24436738

ABSTRACT

Free flap reconstruction of the head and neck is a widespread procedure. The aesthetic outcome is frequently compromised by color mismatch between the donor site skin and the complex pigmentation of the face. Various surgical procedures have been described to improve the appearance of external skin paddles. Medical tattooing is commonly used for nipple pigmentation in breast reconstruction and cosmetic procedures such as permanent makeup. This article describes the technique and its application to head and neck reconstruction. Medical tattooing can be used to improve the cosmetic appearance of head and neck free flaps. There is no donor site morbidity and subtle changes in color can be replicated. The article describes the technique of medical tattooing with the use of illustrative cases. Medical tattooing is a viable alternative for improving the appearance of cutaneous skin paddles following head and neck reconstruction with free flaps. Its advantages include no donor site morbidity, availability of an infinite range of colors, no requirement for general anesthesia, and the ability to use multiple colors in the one flap for complex pigmentation requirements. Its disadvantages include the need for specialized skills and equipment and the fading of color over time.

2.
J Reconstr Microsurg ; 28(2): 85-94, 2012 Feb.
Article in English | MEDLINE | ID: mdl-21780014

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 parascapular flap, one microvascular osteomyocutaneous flap from the subscapular system, and two sequential chimeric free flaps including vascularized bone were used as the initial steps for facial reconstruction. Ankylosis release could spare the temporomandibular joint. Complex noma reconstruction should include skeletal restoration. Avascular bone is acceptable in cases with complete vascularized graft coverage. Microsurgical chimeric flaps are preferable as they can reduce the number and complexity of secondary operations and provide viable, infection-resistant bone supporting facial growth.


Subject(s)
Microsurgery/methods , Noma/surgery , Plastic Surgery Procedures/methods , Surgical Flaps , Adolescent , Adult , Anastomosis, Surgical , Child , Female , Femur/transplantation , Fibula/transplantation , Humans , Infant , Male , Ribs/transplantation , Surgical Flaps/blood supply , Treatment Outcome
3.
Plast Reconstr Surg ; 120(1): 134-143, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17572555

ABSTRACT

BACKGROUND: Most defects resulting from noma involve the lateral and anterolateral aspects of the face and are often combined with severe functional deficits. A subgroup, commonly called "central noma," is composed of defects of the upper lip, maxillary soft tissues, premaxilla, nasal cartilaginous infrastructure, and soft tissues. In contrast to unilateral involvement of the face, central noma does not affect opening of the jaw; however, it results in severe mutilation, with disfiguring three-dimensional defects erasing any individual traits from a face. The common surgical approach to centrofacial noma defects has been single-stage reconstructive procedures using locoregional flaps, but this approach often leads to disappointing outcomes in complex cases. METHODS: The authors' concept for complex central noma defects is a staged approach using free flaps for soft-tissue reconstruction of the upper lip and maxillary vicinity. This approach serves as a versatile base for introducing locoregional flaps for later functional and aesthetic refinements. A secondary procedure includes total nose reconstruction with a free cartilage framework and forehead flaps. RESULTS: In this series (n = 53), free radial forearm (n = 4), anterolateral thigh (n = 1), and parascapular (n = 7) flaps proved suitable for the central face in terms of pedicle length, tissue pliability, and bulk. All free flaps survived completely. Three total nose reconstructions by forehead flaps were performed successfully as a secondary step. CONCLUSION: Being of limited use for subtotal or total reconstruction of the outer nose, microvascular tissue transfer preserves local and regional donor sites--particularly the forehead--for secondary reconstruction.


Subject(s)
Face/surgery , Noma/surgery , Plastic Surgery Procedures/methods , Surgical Flaps , Adolescent , Adult , Child , Child, Preschool , Cohort Studies , Developing Countries , Esthetics , Face/physiopathology , Female , Follow-Up Studies , Graft Rejection , Graft Survival , Humans , Lip/surgery , Male , Maxilla/surgery , Middle Aged , Noma/diagnosis , Nose/surgery , Retrospective Studies , Risk Assessment , Severity of Illness Index , South Africa , Wound Healing/physiology
4.
J Craniofac Surg ; 15(5): 766-72; discussion 773, 2004 Sep.
Article in English | MEDLINE | ID: mdl-15346015

ABSTRACT

Noma defects of the anterolateral face are often associated with fibrous or bony ankylosis fusing the mandibula to the skull base. According to the extent of the ankylosis, the temporomandibular joint mobility can be restricted or even completely frozen. In third world conditions the surgical approach to severe forms of bony ankylosis consists of a single linear opening osteotomy (trismus release) and the closure of the noma defect with locoregional flaps. Relapse of jaw immobility is common and may be caused by minor bone resection, the lack of adequate postoperative physiotherapy, or even the scarring of the defect coverage. In 4 years the authors have gained increasing experience with folded free flaps for simultaneous closure of outer and inner lining of large noma defects and the maintenance and training of re-established jaw function by the use of a dynamic external distractor fixed between the zygoma and the mandibular body. The authors report the bony reankylosis can be reduced by extended wedge osteotomies of the bony bridge and tip-like shaping of the ascending mandibular ramus. To preclude the reossification of the osteotomy site and fibrous scar formation, a dermofatty or muscular tail of the free flap is interposed into the bone gap. Two cases were treated according to this concept with a free parascapular and a latissimus dorsi flap in combination with simultaneous arthroplasty. During a 6-month follow-up period, no signs of a recurrent reduction of mandibular movement were noted in either case.


Subject(s)
Face/surgery , Noma/complications , Noma/surgery , Plastic Surgery Procedures/methods , Surgical Flaps , Adolescent , Adult , Ankylosis/etiology , Ankylosis/surgery , Arthroplasty/methods , Female , Humans , Male , Muscle, Skeletal/transplantation , Nigeria , Osteogenesis, Distraction , Osteotomy/adverse effects , Osteotomy/methods , Plastic Surgery Procedures/adverse effects , Reoperation , Secondary Prevention , Skin Transplantation , Surgical Flaps/blood supply , Temporomandibular Joint Disorders/etiology , Temporomandibular Joint Disorders/surgery , Trismus/etiology , Trismus/surgery
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