Andreas S Heitland1, Norbert Pallua. 1. Department of Plastic Surgery, Hand Surgery/Burns Unit, University Hospital Aachen, Aachen University of Technology, Aachen, Germany. dr-heitland@t-online.de
Abstract
BACKGROUND: Noma is a disfiguring disease requiring a complex therapeutic strategy involving a range of approaches, from skin grafts to local flaps, pedicled flaps, and free flaps. The surgeon must adapt his or her choice of therapy to the patient and, especially in the Third World, to local healthcare environments. METHODS: The authors describe 10 case reports from a stay at the Noma Children's Hospital, in Sokoto, Nigeria, where they used the supraclavicular island flap as a new therapy option for the reconstruction of large facial defects resulting from noma infection. In combination with local mucosa or skin grafts, the supraclavicular island flap was used as an outer lining and also, in three cases, as an inner lining in the form of a double-folded flap. RESULTS: The authors were able to use a pedicled supraclavicular island flap to cover defects as large as half of the face. All 10 pedicled supraclavicular island flaps survived; the only exception was a partial flap necrosis resulting from incorrect application of a wound dressing that kinked the pedicle of the flap. CONCLUSIONS: The authors recommend consideration of the supraclavicular island flap in combination with mucosal or skin grafts as a reliable and safe option for covering most facial defects in noma patients. Because of its simplicity and reliability, this flap replaced the deltopectoral flap and the latissimus dorsi flap as "workhorses," actually reducing the indication for free flaps to the face in cases of large full-size defects. Double folding the supraclavicular island flap is possible, but further clinical studies are needed.
BACKGROUND:Noma is a disfiguring disease requiring a complex therapeutic strategy involving a range of approaches, from skin grafts to local flaps, pedicled flaps, and free flaps. The surgeon must adapt his or her choice of therapy to the patient and, especially in the Third World, to local healthcare environments. METHODS: The authors describe 10 case reports from a stay at the NomaChildren's Hospital, in Sokoto, Nigeria, where they used the supraclavicular island flap as a new therapy option for the reconstruction of large facial defects resulting from noma infection. In combination with local mucosa or skin grafts, the supraclavicular island flap was used as an outer lining and also, in three cases, as an inner lining in the form of a double-folded flap. RESULTS: The authors were able to use a pedicled supraclavicular island flap to cover defects as large as half of the face. All 10 pedicled supraclavicular island flaps survived; the only exception was a partial flap necrosis resulting from incorrect application of a wound dressing that kinked the pedicle of the flap. CONCLUSIONS: The authors recommend consideration of the supraclavicular island flap in combination with mucosal or skin grafts as a reliable and safe option for covering most facial defects in nomapatients. Because of its simplicity and reliability, this flap replaced the deltopectoral flap and the latissimus dorsi flap as "workhorses," actually reducing the indication for free flaps to the face in cases of large full-size defects. Double folding the supraclavicular island flap is possible, but further clinical studies are needed.