The use of the pedicled forehead flap innoma reconstructive surgery.

A noma patients with large unilateral facial defects were reconstructed using the pedicled forehead flap technique in the Muhammad Hoesin Hospital in Palembang, South Sumatera. The results are—although not completely perfect—encouraging enough to report and to repeat the technique in future reconstructivenoma surgery. It is advised not to tunnel the pedicle inthe neck, but instead to open the neck. Then, the flap can be inset in a Z-plastyfashion to close the neck without the chance of compression of the pedicle of theflap. In this way flap necrosis can be prevented, without the risk of a scar contractureof the neck. Another technique, which can prevent partial flap necrosis and loss oftissue, with the need for secondary stage interventions, is a delay procedure of theflap. Incorporation of the fascia in the pedicled supraclavicular flap can be anotheroption to fulfil the abovementioned requirements.

Noma (oro-facial gangrene, necrotising ulcerativestomatitis, stomatitis gangrenosa, or cancrumoris) is a devastating oro-facial gangrene thatoccurs almost uniquely among children in lessdeveloped countries, during the weaning period.1,2The most important risk factors are: poverty,malnutrition, a compromised immune system,poor oral hygiene and a lesion of the gingivalmucosal barrier, as well as an unidentified bacterialfactor.3 The disease has an estimated global yearlyincidence of 25 600–140 000 cases and a mortalityrate of approximately 90%.4 Patients that survivethe acute noma stages generally suffer from itssequelae, including serious facial disfigurement,trismus and ankylosis, oral incontinence, andspeech problems.5 This is why noma has been called‘the face of poverty’.5