Primary and Secondary Procedures in Functional and Aesthetic Reconstruction of Noma-Associated Complex Central Facial Defects

Abstract

Being of limited use for subtotal or total reconstruction of the outer nose, microvascular tissue transfer preserves local and regional donor sites--particularly the forehead--for secondary reconstruction.

Lip Reconstruction

“…11 With the advent of perforator flaps, the thoracodorsal artery perforator flap, internal mammary artery perforator flap, anterolateral thigh flaps, and lateral arm flaps have become options for facial reconstruction available to the reconstructive microsurgeon. 12 Perforator flaps allow tissue to be thinned based on a preferential cutaneous blood supply and in theory are fascial and muscle sparing thus reducing donor-site morbidity. These flaps typically provide reasonable color match and, depending on body habitus, have the ability to be folded and contoured re-creating the internal and external lining of the lip.…”

Experiences with functional gracilis muscle flap in lower lip reconstruction

“…With the advancement of perforator flaps, they have become options for lip reconstruction available to the reconstructive microsurgeon. Perforator flaps allow tissue to be thinned based on a preferential cutaneous blood supply and have minimal donor‐site morbidity . Composite anterolateral thigh‐fascia latae flap have been reported as a good alternative to radial forearm‐palmaris longus flap for total lower lip reconstruction .…”

Lip Reconstruction Using Karapandzic Flap

“…Wider defects may require the skin excess to be resected in a curvilinear alar groove or labiomental pattern allowing the remaining lateral lip or lip-cheek junction to advance medially. 4,6 Full-thickness defects require meticulous attention to obtain a 3-layer closure of mucosa, muscle, and skin. The mucosa must be aligned and everted to provide a watertight mucosal seal.…”

“…The lips have a role in aesthetic balance, facial expression, and speech. 1,4 The aesthetic goals of lip reconstruction are to provide adequate replacement of external skin while maintaining the aesthetic balance of the vermiliocutaneous junction and lip aesthetic units. The functional goals of lip reconstruction are to maintain intraoral mucosal lining and to preserve the surface area of the oral aperture.…”