Patient A.A. , 1979 y/b ., has admitted to Erebouni MC in 18. 08.2016 with coarse disfiguring face scars, which were formed after chemical burn (acids) by a year ago. As a result of a burn the patient lost the left eye, were formed the scars tightening of upper and lower lips, the entire left half of a face and neck. There was a pronounced scar deformity of the right eyelid with a significant restriction of the visual field. The left nostril was absent.
All this have caused the complete social maladjustment of the patient: he hides the face by a bandage and avoids contacts, including relatives and friends. In practice we do not often meet this kind of patients, since the problem is not only medical, but also it is social, economic, and even more psychosocial. These patients usually have isolated lifestyle.
For achieving a maximum aesthetic and functional results, in many European countries and the USA the total or partial transplantation of faces is performed. However, due to the lack of necessary legislation in RA for such kind of surgery, the auto-transplantation techniques is used.
For this large and complicated operation plastic surgeons have been preparing for a long time. After a thorough examination and morphometric measurements the team of plastic surgeons under supervision of Head of Plastic Surgery and Microsurgery Department Dr A.R. Hovhannisyan (MD, PhD) dissection of all coarse and tightening scars of the face and neck had implemented. The microsurgical autotransplantation of composite skin-fascial flap taken from scapular was used. The left nostril, upper and lower lips and corner of the mouth was formed on a vascular pedicle. The deformation of right eyelids was corrected. By the end of the operation blood supply in the flap was restored through major vessels of the neck (carotid artery and jugular vein).
Post-surgical period was uneventful, due to competently and adequately conducted infusion, transfusion and substitution treatment.
At present the patient is discharged from the hospital with significant improvement of both physical, emotional and psychological status. The patient will have a number of cosmetic surgeries for restoration of eyebrows, hair of temporal region, prosthetics of the left eye.
The other patient A.B.,34 y/o, has admitted to Department of Plastic Surgery and Microsurgery with a defect of a lower jaw, formed after radical removal of the tumor. The doctors took on a difficult task – to restore the lower jaw defect. The solution was in the use of own vascularized tissues (as described in the case above).
The surgery was performed by two multidisciplinary teams under the supervision of Head of Plastic Surgery and Microsurgery Department of Erebouni MC, Dr. A.R. Hovhannisyan (MD): one team of maxillofacial surgeons, who prepared the bed for bone grafting, and other team of plastic surgeons, who formed and transplanted the blood supplying fragment of the fibula (calf bone).
Post-operational period was uneventful and the patient was discharged in a week. Then the patient is planning to undergo the imposition of dental implants with complete restoration of occlusion.
Contemporary possibilities of plastic and reconstructive surgery allows fundamentally, completely and aesthetic solve surgical problems related to the replacement of tissue defects, and thus get complete, anatomic and functional restoration. The special attention is paid to aesthetic aspects, which are highly important for the patients too.
