We report a cohort of 148 African children operated on between 1985 and 200
0 for noma sequelae. A total of 440 operations were performed. Lesions incl
uded mouth constriction in 70 of 148 cases, and severe bone destruction in
69 of 148 cases. A large proportion of children was transferred to Switzerl
and for surgical treatment, whereas the others were operated on in local ho
spitals in Africa. Vascularized calvarium flap was mostly used for bone rec
onstruction (n = 36). Pedicled latissimus dorsi myocutaneous flap was the p
referred strategy for cheek reconstruction (n = 40). Expanded frontal flap
was used for nasal reconstruction (n = 18), and pedicled heterolabial flap
for lip construction (n = 37). Given the elevated level of recurrence of mo
uth constriction (extraarticular ankylosis), a minimum of 2 years' follow-u
p after surgical treatment was considered mandatory. Follow-up was conducte
d by field nurses from the humanitarian organizations, and a third of the p
atients were seen directly by our surgical team during special missions to
Africa.