A 60-year-old woman with a history of Systemic Lupus Erythematosus with continuous and prolonged use of corticosteroids and hypertension under control by Cardiology.
The patient reported that during one year, she had undergone a series of polymethylmethacrylate (PMMA) episodes in the upper lip, grooves in the genitalia and malar regions.
The last wound was closed, followed by dry necrosis that compromised the entire upper lip and injured with extensive bloody over the lip with total destruction of its thickness.
The patient requested specialized help, according to her report, in dozens of private services and numerous institutions of Plastic Surgery in the country, which denied her assistance (sic).
On physical examination, 3 of this sprout, we observed: total necrosis with destruction of the entire thickness of the upper lip, extravasation continues to present an acceptable secretion of the wound covering all the inoculum, fibrin associated to the spur.
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During 2 weeks, the patient was treated with systemic antibiotic combination of amoxicillin 875mg and clavulanic acid 125mg (in total 10 days) accompanied by antisepsis and local cures with bilateral central venous accessory defect 2.6 cm.
We released the Abbé flap at 21 days, associating reconstruction at this time of the lower lip with multiple zetaplasty in mucosal and cutaneous areas respectively.
Three months later, the patient underwent a third surgical procedure in which a left lateral x acrylic orthodized prosthesis was made on the lower molars. This prosthesis was prepared and protected for bilateral x 1 cm posterior tongue flaps.
These flaps were performed at 14 days, with excellent anterograde and retrograde perfusion.
At 2 months we performed a fifth surgical intervention in which we treated persistent deformities in the mucosa and in the cutaneous-mucosal transition line of the upper lip with multiple zetaplasties.
It was necessary to associate a cheiloplasty type Cardoso to reduce lip height.
Seven months later, we submitted the patient to a sixth surgical procedure. This time we removed the cutaneous-mucosal transition line between skin and mucosa and the superior crest arch using a bilateral skin fold reduction technique associated with a subcutaneous Gperposition.
After 7 months, we brought the new patient to the operating room for a right seventh surgical intervention in the lower third, in which we reduced slightly more the lip height, narrowed the nose and performed cubic resections of one side ging.
Continuing the refinement surgeries, 5 months later, we performed an eighth surgical procedure to rotate and correct the discrete cleft lip using the Sheen technique associated with a W-plasty for mucomuscular excision.
One month later, we used a galeal fascia graft to assign the right archuaplasts to the left archwires in delimiting the labial line, together with a new cutaneous filter or a zelic transition line on the mucosa.
Finally, completing almost 3 years of surgical treatment to achieve a satisfactory aesthetic result, and 5 months after the last intervention, the patient underwent resection of the excess internal mucosa of the lower lip on the left side Cumetrization transition of the cutaneous arch.
