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Burns of the head and neck
... 3 especially, the neck with its propensity to develop severe contractures and its aesthetic importance, deserves utmost attention. 4 Skin grafts remain a valuable weapon in the reconstructive surgeon's armory, for example, in addressing post burn contractures or defects on the face, neck, and dorsum of the feet. Full thickness skin grafts (FTSGs) are favored over split-thickness grafts principally due to lower recurrent contracture rates and better color match. ...
Optimizing functional and aesthetic outcomes in post burn head and neck reconstruction remains a surgical challenge. Recurrent contractures, impaired range of motion, and disfigurement because of disruption of the aesthetic subunits of the face, can result in poor patient satisfaction and ultimately, contribute to social isolation of the patient. Despite advancements in post burn head and neck reconstruction, such as the advent of free-tissue transfer, split thickness skin graft remains the mainstay of cover in most burn care institutions around the world. Usually skin graft is required to cover raw area after release of contracture. But in case contracture is associated with non-healing ulcer which may become source of infection then skin grafting for non-healing ulcer should be done before release of contracture. In this study we are sharing our experience of post burn neck contracture associated with non-healing ulcer in which first skin grafting was done for ulcer & then release of contracture & skin grafting was done.
Background:
Optimizing functional and aesthetic outcomes in postburn head and neck reconstruction remains a surgical challenge. Recurrent contractures, impaired range of motion, and disfigurement because of disruption of the aesthetic subunits of the face, can result in poor patient satisfaction and ultimately, contribute to social isolation of the patient. In an effort to improve the quality of life of these patients, this study evaluates different surgical approaches with an emphasis on tissue expansion of free and regional flaps.
Methods:
Regional and free-flap reconstruction was performed in 20 patients (26 flaps) with severe postburn head and neck contractures. To minimize donor site morbidity and obtain large amounts of thin and pliable tissue, pre-expansion was performed in all patients treated with locoregional flap reconstructions (12/12), and 62% (8/14) of patients with free-flap reconstructions. Algorithms regarding pre- and intraoperative decision-making are discussed, and complications between the techniques as well as long-term (mean follow-up 3 years) results are analyzed.
Results:
Complications, including tissue expander infection with need for removal or exchange, partial or full flap loss, were evaluated and occurred in 25% (3/12) of patients with locoregional and 36% (5/14) of patients receiving free-flap reconstructions. Secondary revision surgery was performed in 33% (4/12) of locoregional flaps and 93% (13/14) of free flaps.
Conclusions:
Both locoregional as well as distant tissue transfers have their role in postburn head and neck reconstruction, whereas pre-expansion remains an invaluable tool. Paying attention to the presented principles and keeping the importance of aesthetic facial subunits in mind, range of motion, aesthetics, and patient satisfaction were improved long term in all our patients, while minimizing donor site morbidity.
This is a clinical prospective study with preoperative and post operative evaluation of treatment options for post burn complications and prevention. In this clinical research 46 patients were opted even more than 200 cases had being treated. This study was over 2 years period and we kept only those patients who came for follow up for 6 months to 2 years. Most of the patients were between age 4 years and 46 years, only one was 70 years and 3 patients were less than 3 years old.32 patients were female and 14 were male. Most the patients were flame burn only 2 were acid victim females with neck contracture. Contracture involves neck, axilla, elbow, hip joint, knee joint. Treatment options were Skin graft, Z-Plasty and local flaps. Patients who were going through treatment of burn and with risk of post burn contracture were splinted to prevent this complication.
The surgical management of anterior neck contractures, related to burn injuries, is a challenging problem for reconstructive surgeons. The use of sensate expanded radial forearm fasciocutaneous free flaps in two patients suffering from anterior burn contractures of the neck is presented as an alternative method of surgical management. The advantages of employing sensate expanded radial forearm free flaps to reconstruct anterior neck contractures are also discussed in this paper. (C) 1996 Elsevier Science Ltd for ISBI.
Neck contractures after burn produce restrictions in motion and unacceptable aesthetic outcomes. Proper planning and tissue selection is essential to minimize donor site morbidity while optimizing outcomes. A classification system and treatment algorithm aids in achieving this goal. Between December 1999 and January 2003, 40 burn patients underwent release and reconstruction with free perforator flaps. Neck extensibility and zone of injury were evaluated. Choice of reconstruction was based on available tissue, restriction degree and zones involved. Cervical territories were classified according to movement restrictions and amount of improvement. Reconstructive territories were classified as central above (CA), central below (CB), central above and below (CAB) and lateral (L). Single, split, double and preexpanded free flaps were used for the reconstructions. Maximal gain in motion was noted at 4 weeks and maintained for the average 11 months follow-up. Types of reconstructive territories showed significant effects on range of motion while etiology and time between injury and reconstruction showed no impact on the functional outcome. Classification of neck territories aids in improving outcomes while minimizing donor morbidity. The central above territory, when reconstructed with free flaps, yielded the most rewarding improvement. A classification and treatment algorithm aids in achieving significant improvements in range of neck motion while taking into consideration the donor sites.
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