Giessler Goetz A, Schmidt Andreas B
Department of Plastic, Hand, and Reconstructive Microsurgery, BG Trauma Center Murnau, Murnau am Staffelsee, Germany.
Plast Reconstr Surg. 2003 Sep 15;112(4):947-54; discussion 955-6. doi: 10.1097/01.PRS.0000076217.58995.E2.
Noma (cancrum oris) is a serious ulcerating disease that generally begins in the gingival sulcus of children. One of the main areas of prevalence today is West Africa. If noma is survived, it results in disfiguring midfacial defects and intense scarring. Oral incompetence is often combined with trismus resulting from scar formation or bony fusion between the maxilla and the mandible. Reconstructive approaches with pedicled flaps from the head or shoulder area for closure of the outer defects have been prone to donor-site complications or have not properly addressed the trismus, leading to high recurrence rates. During three West African Interplast missions, a single-stage procedure was developed for reconstruction of the inner and outer linings of the oral, nasal, and paranasal cavities, with restoration of jaw function. The procedure consists of radical scar excision, placement of an external distractor for mouth opening, and primary closure of the defect with a folded free parascapular flap for full-thickness coverage. Twenty-three patients with various noma-related defects were treated with this procedure; two cases are described in detail. This combined treatment can be a safe successful procedure for patients with noma, especially those with severe soft-tissue destruction and profound trismus, even under demanding surgical conditions.
坏疽性口炎（走马疳）是一种严重的溃疡性疾病，通常始于儿童的牙龈沟。如今主要流行地区之一是西非。如果坏疽性口炎患者存活下来，会导致面部中部毁容性缺损和严重瘢痕形成。口轮匝肌功能不全常与因瘢痕形成或上颌骨与下颌骨之间骨融合导致的牙关紧闭同时出现。采用头部或肩部带蒂皮瓣修复外部缺损的重建方法容易出现供区并发症，或者未能妥善解决牙关紧闭问题，导致复发率很高。在三次西非国际整形外科任务期间，开发了一种单阶段手术方法，用于重建口腔、鼻腔和鼻旁窦的内、外衬里，并恢复颌骨功能。该手术包括彻底切除瘢痕、放置用于开口的外部牵张器，以及用折叠的游离肩胛旁皮瓣一期闭合缺损以实现全层覆盖。23例患有各种与坏疽性口炎相关缺损的患者接受了该手术治疗；详细描述了2例病例。这种联合治疗对于坏疽性口炎患者，尤其是那些软组织严重破坏和牙关紧闭严重的患者，即使在苛刻的手术条件下，也可能是一种安全、成功的手术方法。
