Maxillo-facial surgery : a flap to reconstruct a face

Chirurgie maxillo-faciale : un lambeau pour reconstruire un visage

A flap to reconstruct a face.

“Refigurer”. The maxillo-facial surgery, complex and delicate, has the goal of giving a face of a patient disfigured. By this neologism, the doctors of this discipline, the heirs of the keepers of the “broken faces” of 1914-1918, define their specialty.

Pr Patrick Goudot, head of the department of maxillofacial surgery of the university Hospital of Pitié Salpêtrière hospital (Paris) refers to a profession that is unknown.

The commemorations on the occasion of the centenary of the First world War allow the discussion of progress fabulous on facial reconstruction from the ‘broken faces’ of 1918. The publication of the novel by Philippe Lançon The Flap is another reason for discussing this surgical discipline sharp and often spectacular.

Cancer, birth defects, suicide attempts…

“The biggest part of our job today is much more oriented towards cancer, growth disorders of the face and malformations, pediatric”, says the Pr Goudot. Besides the infectious causes, often of dental origin, the dog bites in children and suicide attempts by firearm.

The procedure is a long and painful process for the patient, thorough, and complex for the practitioner. Philippe Lançon is disfigured in the attack that claimed the lives of 12 people at the editorial conference of Charlie Hebdo on 7 January 2015.

It has just received the prix Femina for his story telling especially in its reconstruction, and the course surgery which has allowed him to regain a full face. His text gives to see an example of this fraught with risk, physical and psychological.

Rebuild it using a flap

Patients benefit from the immense progress made since the 1970’s and 80’s. “It is the rise of microsurgery, to make the suture of arteries and veins which has helped to develop the use of flaps, such as the one a story of Philippe Lançon “, explains Patrick Goudot.

“Unlike the early days of this specialty, we take the flap you need on the most suitable fabrics.” In this case, “a fragment of fibula to reconstruct the lower jaw of the author and the skin next to the bone to cover the chin. As well as the muscle of the same fibula to wallpaper the inside of the oral cavity. The fed by its own network of blood vessels connected to the veins of the neck”.

A performance ? Before the 1970s, the flaps should remain connected to the blood vessels of the body part drawn. The interventions were therefore more difficult and less efficient. But all the obstacles have not been so far swept away. “We must rebuild the os, a dermal envelope, and a coating of the mucous membranes. It is this multi-tissularité which remains complex,” says the surgeon.

As many difficulties to overcome in block to the surgeon, and on a daily basis to the patient, in order to give a human figure to a disfigured face, on the morphological and functional. “It is necessary that the patient can chew, speak, feel…”, details there. Because “sitting around a table, in company, in front of itself it was someone who talks to you and eats”. Mirror of ourselves, the face is essential to interact with our peers.

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