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ID: 1823 (Conflict of Interest: K)

Gesichtsverstümmelungen durch Rebellen im Kongo

C.Sachs1, K.Kassem2, A.Charpentier3, G.Lemperle4
1Martin Luther Krankenhaus Berlin, Berlin
2Schwarzwald-Baar Klinikum, Donaueschingen
3Universitätsklinikum Bonn-Venusberg, Bonn
4, Frankfurt

Einleitung

In the Democratic Republic Congo, a treaty between rebels and government was finally achieved in 2013.  Most rebels were former soldiers, who had nothing learned but killing and who had changed fronts because of better salaries. Now, they have no chance to return to their former Army and they are damned to make their living in the bush, raiding villages, and stealing whatever they find.

Material und Methoden

Ergebnisse

Two gold diggers in such a village denied having gold nuggets from the river close by and were tortured therefore by the rebels. They cut finger by finger of both of them, and then both ears, and then they searched the gold diggers house, and found some gold nuggets. In order “to never lie again” the rebels cut off total upper and lower lips of these two men. They were flown to the Red-Cross-Hospital in Goma, Congo, where an Interplast-Germany team was operating in another hospital. There, the team reconstructed the upper lips by facial advancement flaps from both facial sides, undermining the cheeks up to the ears, and narrowing the flaps in the midline. Sufficient inner lining could be forwarded from the cheeks as well. In the same operation, the lower lips were reconstructed by visor flaps from under the chin and inner lining from vertical mucosal flaps.

Further punishment of other villagers by the rebels was a shot from below the chin blowing away the chin bone, but leaving the rest of the face intact. These 6 young men could not chew anymore because both mandibular arched contacted each other in a V-shape in front.  Mandibular reconstruction was performed with titanium plates and free iliac bone grafts, and skin coverage of the chin was achieved with two vertical neck flaps.

Schlussfolgerung

There are no similar cases of total upper lip reconstruction in surgical text books or surgical literature – even if cheek advancement is a common procedure in the surgery of wide cleft lips. Most textbooks and articles describe vertical nasolabial flaps, horizontal frontal flaps, or platysma flaps from the neck (to be used mainly for inner lining), or free microsurgical flaps from the forearm (Chinese flap). This simple and effective technique appears to be preferable because it prevents further mutilation of the face.



Fig.1: Reconstruction of upper and lower lip with two cheek advancement flaps and one visor flap from the neck.