AIM

Dorsal metatarsal artery perforator flap (DMTAPF) reconstructions were reviewed to assess indications for application, variation of surgical technique and the long-term impact of growth.

METHOD

A cohort of 15 children presented with 17 DMTAPFs on 16 feet. Patient demographics, the aetiology and timing of primary injury and details of flap reconstruction were recorded. Flap pedicle location, the soft tissue composition and complications were recorded. The active range of motion (AROM) of ankle and toes was compared to the uninjured side. Photographic records of both feet were compiled.

RESULTS

Post-reconstruction follow-up attendance was 94%. Motor Vehicle Accidents (MVA) were the most common primary cause of injury. Most DMTAPF reconstructions were applied electively at toe-extension contracture release. One DMTAPF was applied acutely for a traumatic defect. The mean age at flap review was 10 years. The mean interval between DMTAPF reconstruction and outcome-review clinic was 2 years. The flap was composed of skin +/- scar tissue with an intact adipo-fascial component. A single perforator pedicle was employed in most. Direct donor site closure was supplemented with skin graft (predominantly full-thickness). There were no major donor site complications or skin graft loss. Flap complications were rare and minor. No post-operative revisions were required. Recurrent extension contracture was rare. Post-operative AROM was within a functional range.

CONCLUSIONS

DMTAPF provides a vascularised cover for exposed bones, joints and tendons. Previous scarring, or grafting, are not contraindications to donor site selection. All four webspace perforators are potential pedicles. Flap and donor site complications are rare. This pliable flap kept pace with growth avoiding recurrence of extension deformity. Patients' activities and comfort improved after reconstruction.

BACKGROUND

Noma is a gangrenous infection of the face that results in severe facial deformity, occurring primarily in malnourished and impoverished populations.

OBJECTIVE

To assess clinician- and patient-reported outcomes (PROs) before and after reconstructive surgery for patients with noma in northwest Nigeria.

METHODS

Objective outcomes were recorded using the noma-specific NOITULP (nose, outer cheek, inner cheek, trismus, upper/lower lip, particularities) classification system. PROs were recorded using a locally developed tool. Postsurgical changes were assessed by Wilcoxon signed-rank testing. Linear regression was used to look for associated risk factors. The inter-rater reliability (IRR) of the NOITULP score was assessed using the weighted kappa statistic.

RESULTS

Forty-nine patients (median age 25 years, 71% male) underwent local/regional flap reconstruction and/or trismus release. Twelve complications were reported. Univariate analysis showed a 3.20 change in PRO score (95% confidence interval 0.59 to 5.81, p = 0.018) per kilogram the patient underwent at time of surgery. The NOITULP score improved from a presurgery median of 3.5 to 2.3 (p < 0.0001), however, the IRR was poor (kappa = 0.0894, p < 0.0001). The PRO score also improved from a median of 7.0 to 12.0 (p < 0.0001).

CONCLUSIONS

Facial reconstructive surgery improves the NOITULP score and PROs in patients with noma in northwest Nigeria.