Hartman Ed H M, Van Damme Philip A, Sauter Hartwig, Suominen Sinikka H H
Department of Plastic Surgery, Radboud University Medical Centre Nijmegen, Reinier Postlaan 4, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
J Plast Reconstr Aesthet Surg. 2006;59(4):337-42. doi: 10.1016/j.bjps.2005.10.005.
Three noma patients with large unilateral facial defects were reconstructed using the pedicled supraclavicular flap technique in the Noma Children Hospital in Sokoto, Nigeria. The results are-although not completely perfect-encouraging enough to report and to repeat the technique in future reconstructive noma surgery after moderate modifications. It is advised not to tunnel the pedicle in the neck, but instead to open the neck. Then, the flap can be inset in a Z-plasty fashion to close the neck without the chance of compression of the pedicle of the flap. In this way flap necrosis can be prevented, without the risk of a scar contracture of the neck. Another technique, which can prevent partial flap necrosis and loss of tissue, with the need for secondary stage interventions, is a delay procedure of the flap. Incorporation of the fascia in the pedicled supraclavicular flap can be another option to fulfil the abovementioned requirements.
在尼日利亚索科托的诺马儿童医院，采用带蒂锁骨上皮瓣技术对3例单侧面部大面积缺损的坏疽性口炎患者进行了重建。结果虽不完全完美，但足以令人鼓舞，值得报告，并在未来对坏疽性口炎进行重建手术时，在适度改进后重复该技术。建议不要在颈部将蒂部做成隧道状，而是切开颈部。然后，皮瓣可以采用Z成形术的方式植入，以闭合颈部，避免皮瓣蒂部受压。这样可以防止皮瓣坏死，且没有颈部瘢痕挛缩的风险。另一种可以防止皮瓣部分坏死和组织丢失，避免二期干预的技术是皮瓣延迟手术。在带蒂锁骨上皮瓣中纳入筋膜可能是满足上述要求的另一种选择。
