Article

Treatment of Postburn Anteriorly Located Neck Contractures With Local Flaps

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Abstract

The objective of this study was to summarize our experience of using local flaps for the reconstruction of neck defects after cervical contractures release, particularly of using the extended deltopectoral flaps whose distal margin was beyond the anterior axillary line even reaching dorsalis for reconstruction of anterior neck scar contractures in a single-stage procedure. From 1987 to 2008, neck scar contractures were reconstructed using various local flaps in 68 patients with postburn anteriorly located neck contractures. The local flaps used consisted of 36 deltopectoral flaps, 6 extended deltopectoral flaps, 4 free scapular flaps, 8 neck-shoulder flaps, and 14 Z-plasties. The distal end of extended deltopectoral flaps was transferred as microvascular-free flap provided by the posterior circumflex humeral artery, but the proximal end as pedicle flap supplied by the anterior perforating branches of internal mammary artery. Other flaps were elevated conventionally as described previously in the articles. Of 68 patients, there were 59 cases (86.8%) whose release of the contractures was excellent. For 51 patients, the whole process of treatment was finished only in a single-stage procedure. We used extended deltopectoral flap, which was developed from our own anatomic studies and from previous reports in the literature, in 6 patients. This new flap extends the volume of the original deltopectoral flap, from 22 to 32 cm in length and 10 to 22 cm in width (at the apex). Postoperatively, all flaps survived completely. Patients were satisfied with their results. The follow-up period ranged 1 to 10 years; no obvious recontractures have been noted. There were no severe donor-site complications. The local flap with matching texture, color, elasticity, and pliability is still the best choice for reconstruction of postburn anteriorly located neck contractures. The extended deltopectoral flap has been used successfully to yield satisfactory outcomes for the scar contractures in the anterior neck and should be conserved as a selective method for reconstructive surgeons.

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... Second, we will spend some time on the acute management of burn injuries, due to our bias that the best reconstructive plan really begins during this initial period; victories and errors that occur early in the healing process can have profound implications on the simplicity or complexity of approaches needed for later reconstruction [11][12][13][14][15][16][17][18][19][20][21]. Third, we will illustrate reconstructive options for specific anatomic areas, providing our perspective on tips and tricks that may not appear in textbooks or journal articles but have accumulated over decades of practice [22][23][24][25][26][27][28][29]. As such, this chapter is not evidencebased, but rather experiential. ...
Chapter
Burn reconstruction of the head and neck draws upon the principles and techniques from across the field of plastic surgery to restore form and function. In this chapter, we will review both the acute management of head and neck burns and reconstruction of late defects. We will also emphasize general principles that can guide reconstructive strategies. Finally, we will illustrate examples of burn reconstruction by anatomic location. In summary, burn reconstruction utilizes a wide array of approaches to anticipate and meet the four-dimensional needs of patients with defects caused by burn injury.
... Scarring and tissue loss from second-and especially third-degree burns spontaneously healed or covered with skin grafts can usually cause deformities, and more rare are posttraumatic sequelae, or after the surgical excision of tumor [1][2][3][4][5]. Multiple treatment alternatives have been used with variable but limited success (skin grafts, Z-plasties, local and distant flaps) [6][7][8][9]. During the last two decades, the development of Integra dermal regeneration templates associated with the use of skin graft and keratinocyte cultures has virtually solved these problems [10,11]. ...
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Contractures to the cervical region as a result of burns has the capacity to cause restrictions in range of movement, function of the lower face, cervical spine distortion and poor aesthetic outcomes that remain a surgical challenge. Consequently, physical and aesthetic deformities as a result of cervical contractures are reported to cause depression having implications for patients' quality of life and psychosocial wellbeing. At the time this research was conducted, there were no case reports describing a closed platysmotomy approach in burn patients. In this article, we review the literature surrounding closed platysmotomies and present what we believe to be the first reported case in the treatment of cervical contractures utilising a closed platysmotomy approach in a burns patient. A closed platysmotomy approach for the treatment of cervical contractures is a less invasive technique. Further investigation is warranted to determine the feasibility of this reconstructive approach in the area of burn scar management.
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