Classification of massive postburn scars on neck and the reconstruction strategy using pre-expanded perforator flaps from the back

Abstract

To explore the classification of massive postburn scars on neck and the reconstruction strategy using pre-expanded perforator flaps from the back. Thirty-seven patients with massive postburn scars on neck were admitted from January 2010 to December 2014 and treated by our treatment group. The massive postburn scars on neck were categorized into three types according to their size and location. Based on the principles of reconstructive ladder, matching in color and texture between donor site skin and neck skin, large size and thinner thickness of tissue of donor site skin, donor-recipient sites balance, and dominant supplying vessel, we proposed the following treatment strategy for choosing perforator flaps from the back. (1) In view of central cervical scar involving the central area (mainly in this area) and one side of peripheral zone, the free circumflex scapular artery perforator flap was chosen. (2) In view of peripheral cervical scar involving the central area and one side of peripheral zone (mainly in this area), the pedicled superficial cervical artery perforator flap was the first choice. In case the pedicled superficial cervical artery perforator flap was unavailable because of the absence of superficial cervical artery perforator or scarring within its vascular territory, the pedicled occipital artery perforator flap, pedicled dorsal scapular artery perforator flap, and free circumflex scapular artery perforator flap were chosen as alternative options considering specific condition. (3) In view of total cervical scar involving the central area and both sides of peripheral zone, the circumflex scapular artery perforator supercharged pedicled superficial cervical artery perforator flap was chosen. Tissue expansion was performed in the first stage for all the patients. In the second stage, after excision of the cervical scars, the flaps were transferred to cover the wounds. Among the 37 patients, 7 were with central cervical scar, 12 with total cervical scar, and 18 with peripheral cervical scar. Among patients with peripheral cervical scar, the pedicled superficial cervical artery perforator flaps were used in 11 cases, pedicled occipital artery perforator flaps in 2 cases, pedicled dorsal scapular artery perforator flap in 1 case, and free circumflex scapular artery perforator flaps in 4 cases. Tip necrosis occurred in 3 flaps of patients after surgery, which were healed by dressing change. The other flaps of patients grew well after surgery. Patients were followed up for 1 to 6 years, and all patients were able to extend neck beyond 110° with no sense of restricted neck flexion or rotation. No contracture of flap was observed. Thirty-five patients were satisfied with their appearance after surgery. Pre-expanded perforator flaps from the back are useful flaps for reconstruction of massive postburn scar on neck. Free circumflex scapular artery perforator flap is recommended for reconstruction of central cervical scar. Pedicled superficial cervical artery perforator flap is the first option for reconstruction of peripheral cervical scar, while the pedicled occipital artery perforator flap, pedicled dorsal scapular artery perforator flap and free circumflex scapular artery perforator flap are alternative options. For total cervical scar, the circumflex scapular artery perforator supercharged pedicled superficial cervical artery perforator flap is recommended.