Eur J Plast Surg (1999) 22: 144 Springer-Verlag 1999 LETTE R T O T HE EDITOR A.T. Telliog Æ lu I read with interest the paper by Mark et al. (Noma: The Finally, I believe that the definitive treatment of Noma Sokoto approach; Eur J Plast Surg 21:277, 1998), they and the use of complex flap procedures described in this spent three weeks in Sokoto, Nigeria and devised a spe- article are almost impossible in the short period of three cial approach for Noma during that period. weeks. Should Noma be treated without sufficient time They used four delayed deltopectoral flaps, three pre- for the complex operative procedures required, without fabricated forehead flaps, and four prefabricated temporo- proper equipment, and without a proper operating theatre? parietal flaps in three weeks. It was stated that the delto- pectoral flap is delayed at 7±10 days and its pedicle is di- vided three weeks after the first operation [1, 2]. The three References week period prior to use of the prefabricated forehead flap 1. Bacamjian VY (1990) Deltopectoral skin flap. In: Strauch B, is not sufficient in nasal reconstruction because the time Vasconez LO, Hall-Findlay L (eds) Grabb's encyclopedia of for flap pedicle division is three weeks without prefabrica- flaps. Little, Brown, Boston, pp 465±475 tion [3, 4]. They reported that the forehead flaps were 2. Konno A, Towaga K, Izuka K (1981) Primary reconstruction af- most frequently used for cheek reconstruction. It has been ter total or extended total maxillectomy for maxillary cancer. Plast Reconstr Surg 67:440 stated previously that one of the major disadvantages of 3. Millard DR Jr (1974) Reconstructive rhinoplasty for lower half the forehead flap is its lack of elasticity, this results in of a nose. Plast Reconstr Surg 53:133 trismus when it is used for repair of cheek defects . Un- 4. Burget GC (1985) Aesthetic restoration of the nose. Clin Plast fortunately, most of their patients had trismus prior to sur- Surg 12:463 gery, thus severe postoperative trismus is inevitable. In 5. Wilson JSP and Breach NM (1990) Forehead skin flaps. In: Strauch B, Vasconez LO, Hall-Findlay L (eds) Grabb's encyclo- addition, it has been shown that the optimal prefabrication pedia of flaps. Little, Brown and Company, Boston, pp 365±379 time for the temporoparietal fascia flap with a skin graft is 6. Erol OO (1976) The transformation of a free skin graft into a three weeks  and the previous reports including experi- vascularized pedicled flap. Plast Reconstr Surg 58:470 ence of the temporoparietal flap with bone for intraoral 7. Acartürk S, Dalay C, Yavuz M (1994) Reconstruction of the wide palatal defects with temporal osteocutaneous island flap. reconstruction requires a longer time than three weeks Eur J Plast Surg 17:195 for prefabrication [7, 8]. A three week period is insuffi- 8. Furnas DW (1987) Temporal osteocutaneous island flap for cient for these patients with severe deformities. complete reconstruction of cleft palate defects. Scand J Plast Re- The anesthesia techniques and the related possible constr Surg 21:119 risks were well discussed by Dr. P. Schüller, and thus I 9. Dijiktra R, Abate GC, Yoo MC (1986) Noma. Eur J Plast Surg 9:46 will not comment on this. 10. Montandon D, Lehmann C, Chami N (1991) The surgical treat- It was stressed that the most important aspect in treat- ment of Noma. Plast Reconstr Surg 87:76 ment of Noma is functional reconstruction of the tempo- 11. Adolp HP, Yugueros P, Woods JE (1996) Noma: a review. Ann romandibular joint [9±11]. However, the authors did not Plast Surg 37:657 truly address the TMJ problems. They only released soft tissue and removed bone without a specific attempt to re- construct the TMJ and without the intensive rehabilitation program which is necessary to prevent recurrence of an- kylosis. A.T. Tellioglu Kenedi Cad 61/8, TR-06660, Kavaklidere ± Ankara, Turkey
European Journal of Plastic Surgery – Springer Journals
Published: Apr 15, 1999
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