Aesthetic Reconstruction of the Postburn Neck Contracture With a Preexpanded Anterolateral Thigh Free Flap

Abstract

The release of wide burn contractures leads to defects that cannot be closed with local flaps. In these cases, tissue expansion of local tissues may be a solution. However, when local tissues are also burned, distant tissue transfer remains the only option. Tissue expanded anterolateral thigh (ALT) flaps can be a reasonable option. A 15-year-old boy with a cervical burn contracture had limited movement in the neck. The release of the contracture and removal of the scarred tissue resulted in a 22 × 18-cm neck defect. This was resurfaced with preexpanded anterolateral thigh perforator flap. Three months postoperatively, the flap shrunk to the point that the underlying aesthetic anatomical landmarks such as the clavicle, sternal notch, sternocleidomastoid muscle, and thyroid cartilage were clearly visible. The reconstruction was both functionally and cosmetically excellent. Tissue expanded ALT can be a good option in wide burn contractures where local tissues are inadequate. The advantages are (1) large flaps can be prepared without any functional loss, (2) the expanded skin thins making it more cosmetically appropriate to resurface skin only defect, and (3) the donor area stays under the clothes during expansion period and is well tolerated by the patient.