RESUMEN
INTRODUCTION AND IMPORTANCE: Facial deformities caused by chemical burns are often complex, seriously affecting the patient's function and quality of life. Treating these injuries requires the incorporation of multi-staged procedures to achieve the desire appearance. CASE PRESENTATION: A 32-year-old male patient had a total face disfigurement after an acid burn injury. He had apparent front, cheek, and lips scarring and complete nose deformities. His eyebrows were lost. Bilateral upper and lower eyelids adhered to the eye socket. He went through 3 primary operations with many different procedures. The treatment time was shortened over 5 months thanks to the appropriate combination of many processes in the same stage and the proper sequence of surgeries. After 7 years of follow up, the patient was satisfied with the aesthetic results, with no functional limitations. CLINICAL DISCUSSION: Reconstruction of total facial burn sequelae is always a challenge for surgeons, as it requires much experience to schedule multi-staged procedures, which takes a long time, choose the appropriate material for different anatomical units, and achieve functional and simultaneous aesthetic improvement. The most important thing is to create a prioritized order, adhere to the principles of subunit reconstruction, pay attention to functional and simultaneous aesthetic improvement, and restore the contour and symmetry of the landmarks. CONCLUSION: By arranging surgeries properly, using suitable reconstructive materials, and paying attention to the integrity of the facial units, an excellent aesthetic and functional outcome can be achieved in a patient with severe facial disfiguration caused by acid burns.
RESUMEN
Objective: The pedicled Internal Mammary Artery Perforator (IMAP) flap is not yet a well-known technique. However, it seems practical for use in thoracic radiation-induced ulcer, especially in recurrence after the failure of convenient reconstructive techniques. This technique is applied to patients with breast hypertrophy. In this article, we present our experience with the indications, surgery details, and advantages of this technique. Materials and methods: A 63-year-old woman had a right mastectomy 11 years ago. The patient's ulcers recurred after radiotherapy and were treated with a regional and local flap. The opposite breast was ptotic, and the patient was not eligible for microsurgery. The patient underwent reconstruction using the contralateral pedicle IMAP flap. Results: The IMAP flap was designed with a size of 14 × 22 cm, including the inferior half of the breast and the areolar. The flap could completely cover the chest wall defect, and the contralateral breast was reduced to match. The final results were evaluated after two years of follow-up. Conclusion: The contralateral breast pedicle IMAP flap is a reliable, versatile, and easy-to-perform technique. This flap is a useful technique for chest wall coverage after radiation-induced ulcers, particularly in elderly patients. The major limitation of this technique is the higher risk of second primary breast cancer as the transfer flap of the contralateral breast.