Surgery for total and subtotal neck contractures with pre-expanded posterior cervicothoracic, cervicoshoulder, and parascapular flaps

Abstract

Restoration of adequate skin coverage, movements and aesthetic neck contours for the anterior chest lesion, as the main donor sites, is one of the important problems of reconstructive surgery.The aim — to improve the surgical treatment results in patients with postoperative total and subtotal cervical neck deformities with pre‑expanded cervicodorsal and cervicoshoulder flaps based on the superficial cervical artery and parascapular flaps based on the circumflex scapular artery.Materials and methods. The study included 12 patients aged from 6 to 48 years. Reconstruction of neck contracture with pre‑expanded cervicodorsal and cervicoshoulder flaps based on the superficial cervical artery and parascapular flaps based on the circumflex scapular artery was done. The tissue areas were based on the surrounding perforated vessels to increase the flaps size.Results and discussion. The practicability and effectiveness of pre‑expanded cervicodorsal and cervicoshoulder flaps feed by superficial cervical artery and parascapular flaps feed by the circumflex scapular artery in total and subtotal scar neck deformities with lesion of the anterior chest wall were shown. A good result with full survival of the flaps was achieved in 13 (76.5 %) cases. The incomplete removal of scars in 3 (17.6 %) patients was rated as a satisfactory result. In 1 (5.9 %) patient, in the postoperative period, a partial necrosis of type 1 flap appeared and the result was assessed as satisfactory.Conclusions. Proper preoperative planning and thorough implementation of surgical intervention ensure good results in 76.5 % and satisfactory — in 23.5 % of cases in the immediate period and good results in all patients — in the remote period.