Nthumba Peter, Carter Louis
Department of Surgery, AIC Kijabe Hospital Kijabe 00220, Kenya Africa.
J Med Case Rep. 2009 Jun 9;3:7312. doi: 10.4076/1752-1947-3-7312.
Noma, 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.
We 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.
The 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.
坏疽性口炎，被恰如其分地称为“贫困之脸”，是一种灾难，死亡率高达90%，每年影响约14万人，主要是撒哈拉以南“坏疽性口炎带”的儿童。急性发作的幸存者因面部组织丧失和瘢痕形成而面部严重毁容。坏疽性口炎缺损的手术重建是一项重大挑战，尤其是在非洲，那里发生了大多数病例。
我们报告了一名40岁索马里男子的病例，他面部严重毁容，包括上下唇完全缺失。初次重建失败后，颈阔肌皮瓣和左侧胸三角皮瓣联合使用提供黏膜内衬，而头皮帽状皮瓣用于再造上下唇、胡须。
头皮帽状皮瓣为面中部重建提供了一种简单但极其通用的工具，尤其适用于男性，可提供新的唇部组织、胡须。这是英文文献中首例使用头皮帽状皮瓣同时进行上下唇完全重建的报告。我们还强调了技能转移过程，以使当地外科医生能够有效应对坏疽性口炎带来的挑战。
