Functional and esthetic considerations in reconstruction of post-burn contracture of the neck

Abstract

Background: Post-burn contracture (PBC) of the neck is a challenging problem for reconstructive surgeons in view of not only functional and esthetic considerations but prolong physiotherapy and splintage as well. The aim of this study is restoration of form and function with special attention to functional and esthetic considerations in reconstructing such defects. Materials and Methods: Total 40 numbers of patients with PBC of anterior neck were studied from 2009 to 2011 in the Department of Plastic Surgery. All the patients were assessed for degree of the extension (cervicomental) angles, the nature of scar tissue, and the available normal skin surrounding the contracting band. The PBC of neck was divided into three categories according to the degree of extension to type-1(mild) when extension angles were >90°, type-2 (moderate) when extension angles were ≤90°, and type-3(severe) with mentosternal synechiae. Contractures with narrow band were treated with Z-plasty in type -1 and Z-plasty along with skin grafting in type-2. Contractures with broad band were treated with flap surgeries with or without skin grafting in type-1 and 2. Contractures in type-3 were treated with only skin grafting. The flaps were local advancement flaps, expanded flaps, and supraclavicular flaps. Results: All type-1a patients were treated with only Z-plasty. One patient in type-1b was treated with expanded flap; the other patient was treated with unilateral supraclavicular flap along with full thickness skin grafting. Seven patients in type-2a contracture were treated with Z-plasty. Here one patient was treated with only Z-plasty, and six patients were treated with Z-plasty along with full thickness skin grafts. Seven patients in type-2b contracture were treated with flap surgery. In type-3, all contractures were released with excision of the scars; and the defects were resurfaced with split thickness skin grafts. The esthetic quality of the neck was judged by the patient, operating team, and patient's relative. The result of postoperative scar neck was also found esthetically fair to good. The cervicomental angle of 100-125° was attained in our cases.