Clinical experience in the treatment of noma sequelae.

We report a cohort of 148 African children operated on between 1985 and 2000 for noma sequelae. A total of 440 operations were performed. Lesions included mouth constriction in 70 of 148 cases, and severe bone destruction in 69 of 148 cases. A large proportion of children was transferred to Switzerland for surgical treatment, whereas the others were operated on in local hospitals in Africa. Vascularized calvarium flap was mostly used for bone reconstruction (n = 36). Pedicled latissimus dorsi myocutaneous flap was the preferred strategy for cheek reconstruction (n = 40). Expanded frontal flap was used for nasal reconstruction (n = 18), and pedicled heterolabial flap for lip construction (n = 37). Given the elevated level of recurrence of mouth constriction (extraarticular ankylosis), a minimum of 2 years' follow-up after surgical treatment was considered mandatory. Follow-up was conducted by field nurses from the humanitarian organizations, and a third of the patients were seen directly by our surgical team during special missions to Africa.