Treatment of a neck burn contracture with a super-thin occipito-cervico-dorsal flap: a case report

Occipito-Cervico-Dorsal Flap for Neck Reconstruction After Postburn Contractures: A Case Report and Literature Review

Because the head and neck are one of the most frequent locations of burns, it is of paramount importance that plastic surgeons and plastic surgical nurses understand the most effective surgical methods for treating neck contractures and the reconstructive technique required for each case. We introduce the case of a 42-year-old woman who presented with a severe postburn neck contracture that was reconstructed with a pedicled occipito-cervico-dorsal flap. We closed the donor-site wound primarily and completely covered the defect with good results. In addition to conventional skin grafts, dermal matrices, and microsurgical techniques, using an occipito-cervico-dorsal flap should be considered for reconstructing postburn neck contractures as it offers good aesthetic and functional outcomes, provides enough tissue and pliable skin, and results in minimal donor-site morbidity.

Aesthetic and Functional Rehabilitation of Postburn Maxillofacial Deformity

Postburn maxillofacial deformities, although rare, are a significant cause of morbidity. Since contracture scars have a potential role in deforming the maxillofacial skeleton, the focus of treatment should be on growing patients, where scar contractures can drastically influence growth and morphology of the maxillofacial units. There are certain aspects of severe facial burns and deformities, especially of the jaws, that deserve sincere attention to overcome aesthetic and functional disabilities such as inability to masticate and incompetent lips. The purpose of this article, therefore, is to discuss these injuries, the mechanism of development of deformities of the jaws and associated structures and their management for better aesthetic, functional, and psychological health of patient. An interpretive clinical report is presented.

Interest of Thin Skin Flaps in the Treatment of Postburn Cervical Contractures: About Five Cases

Objectives

The use of thin skin flaps in the reconstruction of postburn cervical contractures associated with functional impacts.

Material and Methods

We conducted a descriptive observational study on about five patients who had reconstruction of postburn cervical contractures using various thin skin flaps in a plastic surgery department. The follow-up period was ranged from 12 to 18 months. We determined the characteristics of the retraction according to the Vandenbussche classification, the indications of the flaps, and the functional and aesthetic results.

Results

Most of our patients were young adults presenting segmental retraction of the neck associated with moderate functional impact. The occipito-cervico-dorsal flap was used in three cases. The occipito-cervico-shoulder flap was used in two cases. The aesthetic and functional results were satisfactory for all patients, but a “neck-collar” aspect of the cervical-chin angle was noticed.

Conclusion

Postburn cervical contractures remain frequent. Their reconstruction is a difficult process as it is ideally done with a skin similar to the original one. The use of thin skin flaps seems to be an excellent option.

[Cheek reconstruction]

We describe the different cheek reconstruction techniques with primary emphasis on the superficial layers. In addition to the clinical context, location and size of the lesion will be taken into account to choose the best method that will optimize the functional and aesthetic results while minimizing potential sequelae. Main evaluation criteria include absence of natural orifice deformation, scar location, skin cover quality and respect of volumes.

Pre-Expanded Ultra-Thin Supraclavicular Flaps for (Full-) Face Reconstruction with Reduced Donor-Site Morbidity and without the Need for Microsurgery

BACKGROUND

The expanded supraclavicular island flap, as described in 1997 by the senior author (Pallua), is a useful tool for total facial reconstruction, providing satisfactory results without microsurgical prefabrication. The authors report the use of this technique in 12 patients requiring large flaps who presented with extensive facial scarring that had been previously reconstructed using disfiguring, pigmented skin grafts.

METHODS

On the basis of their anatomical dissection studies and knowledge of the constant anatomy of the supraclavicular artery and two draining veins, the authors carefully inserted tissue expanders under the supraclavicular island flaps. After the flaps were expanded, all scars were removed and the covering flaps were transferred into place. Sixteen pre-expanded supraclavicular island flaps were used in 11 patients.

RESULTS

There were no complications.

CONCLUSIONS

The authors present a method of facial reconstruction that has the advantages of creating a large amount of thin tissue of both good color and texture, without the disadvantages of donor-site morbidity, lengthy operative time, and high cost. In their opinion, this is the method of choice for total facial reconstruction.

The microvascular augmented subdermal vascular network (ma-SVN) flap: its variations and recent development in using intercostal perforators

In 1994 we reported the use of the microvascular augmented occipito-cervico-dorsal 'super-thin' flap for reconstruction of the cervical region in three cases. Since this preliminary report, we have performed a further 17 flaps, and the usefulness of the flap in the treatment of anterior cervical scar contractures in extensively burned patients has become apparent. Moreover, we have devised flaps with not only a narrow skin pedicle but also myocutaneous or island vascular pedicles. Various augmentation vessels, including myocutaneous perforators of the intercostal spaces in the back and chest, have also been used successfully. Here, we describe the microvascular augmented subdermal vascular network flaps that we have devised.

The tunneled supraclavicular island flap: an optimized technique for head and neck reconstruction

Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly myocutaneous flaps and skin grafts to free microsurgical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are always essential. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. We have found that the shoulder is a region providing an optimum skin texture match to the neck and face. In cadaver dissection, a vascular pedicle extending from the transversal cervical artery with two accompanying veins was found to vascularize a defined region around the shoulder cap. In line with these findings, the previously described fasciocutaneous island flap, nourished by the supraclavicular artery, was developed further and used purely as a subcutaneously tunneled island flap. The tunneling maneuver significantly improves the donor site by reducing scarring. The flap is characterized by a long subcutaneous pedicle of up to 20 cm. The pivot point is in the supraclavicular region and allows the flap to be used in the upper chest, neck, chin, and cheek. In this article, we introduce the anatomic features and present clinical cases underlining the surgical possibilities of the flap in reconstructive procedures with expanded indications.