An 18-year-old patient, 5 months before, had suffered from severe electrical burns for 13,800 volts in his face when trying to save a coworker.
He had an extensive lesion with loss of both lips and nose.
A large traction of the perioral tricial and adjacent areas prevented the use of any type of local flap for reconstruction of the area.
In the nasal region there was loss of skin substance and nasal lining, as well as part of the cartilage cover of the back, tip, plumb and nasal wings.
He had undergone surgical reconstruction with a frontal flap in another service four months before, but with necrosis.
1.
A reconstruction was programmed using biculate flap of the anterior cervical region, described by Tsur (3), for lip reconstruction and a right supratrochlear flap for reconstruction of the nasal and left for coverage.
There was a partial loss of the left supratrochlear coverage flap and a small partial loss of the right supratrochlear flap for the nasal lining, which were observed 3 days after surgery.
On the fifteenth day, one of the cervical flap pathologies was covered and, after 30 days, the other was covered, after integration of the flap to the upper lip.
From this point on, several flaps were performed under local anesthesia, every 2 months, for reconstruction of the lower lip, the columella and the nasal tip, and the main flap thinning was also performed.
Seven procedures were performed.
During the evolution, persistent residual edema of the cervical flap, keloids and hypersensitivity, appeared in the donor areas that were treated with intralesional corticosteroids.
The final reconstruction, 2 years after performing the Tsur flap, made it possible to create a structure of emotional expression although with limited functionality; the challenges and refinements improved the final result, achieving a satisfactory food appearance and satisfactory patient satisfaction.
Currently, 4 years after the initial surgery, no more surgical treatments have been programmed.
