Postburn Neck Contracture: Principles of Reconstruction and a Treatment Algorithm

Yashan Gao; Haizhou Li; Bin Gu; Feng Xie; Hainan Zhu; Zhichao Wang; Qingfeng Li; Tao Zan

doi:10.1055/s-0038-1641724

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2018; 34(07): 514-521
DOI: 10.1055/s-0038-1641724

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Postburn Neck Contracture: Principles of Reconstruction and a Treatment Algorithm

Yashan Gao^*

¹Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, P. R. China

,

Haizhou Li^*

¹Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, P. R. China

,

Bin Gu

¹Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, P. R. China

,

Feng Xie

¹Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, P. R. China

,

Hainan Zhu

¹Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, P. R. China

,

Zhichao Wang

¹Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, P. R. China

,

Qingfeng Li

¹Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, P. R. China

,

Tao Zan

¹Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, P. R. China

› Author Affiliations

Abstract

Background Various techniques have been developed for postburn neck reconstruction, but a treatment algorithm is needed.

Methods We retrospectively reviewed all patients treated for postburn neck contracture at our institution between February 2008 and December 2015. Necks were divided into one anterior subunit and two lateral subunits marked by the sternocleidomastoid muscle. Deformities were categorized into three types according to their size and location. Type I deformities involve less than one subunit, type II deformities involve at least one subunit but less than two subunits, and type III deformities affect two or more subunits. Type II deformities were further divided into type IIa deformities, which mainly involve the anterior region, and type IIb deformities, which mainly involve the lateral region.

Results Local random pattern flaps were constructed for type I deformities. Pedicled flaps from the anterior chest and supraclavicular areas were preferred for type IIa deformities, and pedicled flaps from the back were preferred for type IIb deformities. Pedicled flaps from other areas were the second choice for type II deformities, followed by free and prefabricated flaps. For type III deformities, bipedicled flaps were usually required. At a follow-up of at least 12 months, all patients showed near-normal neck function, and aesthetic features were significantly improved.

Conclusion The proposed classification and treatment algorithm for postburn neck reconstruction may help achieve satisfactory outcomes.

Keywords

burn injury - neck contracture - neck reconstruction - pre-expanded flap - prefabricated flap

Full Text

References

References
1 Li H, Zhou Y, Du Z. , et al. Strategies for customized neck reconstruction based on the pre-expanded superficial cervical artery flap. J Plast Reconstr Aesthet Surg 2015; 68 (08) 1064-1071
2 Katsaros J, David DJ, Griffin PA, Moore MH. Facial dysmorphology in the neglected paediatric head and neck burn. Br J Plast Surg 1990; 43 (02) 232-235
3 Tsai FC, Mardini S, Chen DJ, Yang JY, Hsieh MS. The classification and treatment algorithm for post-burn cervical contractures reconstructed with free flaps. Burns 2006; 32 (05) 626-633
4 Yang JY, Tsai FC, Chana JS, Chuang SS, Chang SY, Huang WC. Use of free thin anterolateral thigh flaps combined with cervicoplasty for reconstruction of postburn anterior cervical contractures. Plast Reconstr Surg 2002; 110 (01) 39-46
5 Nahlieli O, Kelly JP, Baruchin AM, Ben-Meir P, Shapira Y. Oro-maxillofacial skeletal deformities resulting from burn scar contractures of the face and neck. Burns 1995; 21 (01) 65-69
6 Ninkovic M, Moser-Rumer A, Ninkovic M, Spanio S, Rainer C, Gurunluoglu R. Anterior neck reconstruction with pre-expanded free groin and scapular flaps. Plast Reconstr Surg 2004; 113 (01) 61-68
7 Parrett BM, Pomahac B, Orgill DP, Pribaz JJ. The role of free-tissue transfer for head and neck burn reconstruction. Plast Reconstr Surg 2007; 120 (07) 1871-1878
8 Zan T, Li H, Gu B. , et al. Surgical treatment of facial soft-tissue deformities in postburn patients: a proposed classification based on a retrospective study. Plast Reconstr Surg 2013; 132 (06) 1001e-1014e
9 Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution, classification, and applications. Ann Plast Surg 2003; 50 (01) 90-99
10 Pribaz JJ, Fine N, Orgill DP. Flap prefabrication in the head and neck: a 10-year experience. Plast Reconstr Surg 1999; 103 (03) 808-820
11 Sinha M, Scott JR, Watson SB. Prelaminated free radial forearm flap for a total nasal reconstruction. J Plast Reconstr Aesthet Surg 2008; 61 (08) 953-957
12 Ogawa R, Hyakusoku H. Bipedicled free super-thin flap harvesting from the anterior chest. Plast Reconstr Surg 2004; 113 (04) 1299-1300
13 Kawashima T, Yamada A, Ueda K, Asato H, Harii K. Tissue expansion in facial reconstruction. Plast Reconstr Surg 1994; 94 (07) 944-950
14 Angrigiani C. Aesthetic microsurgical reconstruction of anterior neck burn deformities. Plast Reconstr Surg 1994; 93 (03) 507-518
15 Zhang YX, Wang D, Follmar KE. , et al. A treatment strategy for postburn neck reconstruction: emphasizing the functional and aesthetic importance of the cervicomental angle. Ann Plast Surg 2010; 65 (06) 528-534
16 Li Q, Zan T, Gu B. , et al. Face resurfacing using a cervicothoracic skin flap prefabricated by lateral thigh fascial flap and tissue expander. Microsurgery 2009; 29 (07) 515-523
17 Zhu H, Gao Z, Tremp M. , et al. Application of tissue expansion with perforator flaps for reconstruction of challenging skin lesions. J Reconstr Microsurg 2018; 34 (01) 13-20
18 Mathes S, Nahai F. Clinical Application for Muscle and Musculocutaneous Flaps. St. Louis: Mosby; 1982: 3
19 Gottlieb LJ, Krieger LM. From the reconstructive ladder to the reconstructive elevator. Plast Reconstr Surg 1994; 93 (07) 1503-1504
20 Achauer BM. Reconstructing the burned face. Clin Plast Surg 1992; 19 (03) 623-636
21 Remensnyder JP, Donelan MB. Reconstruction of the head and neck. In: Herndon DN. , ed. Total Burn Care, 3th ed. London: Saunders; 2002: 656-689
22 Perera C, Fudem GM. Aesthetic reconstruction of severe postburn neck contractures. Ann Plast Surg 2008; 61 (05) 559-565
23 Edgerton MT, Hansen FC. Matching facial color with split thickness skin grafts from adjacent areas. Plast Reconstr Surg Transplant Bull 1960; 25: 455-464
24 Zan T, Li H, Du Z. , et al. Reconstruction of the face and neck with different types of pre-expanded anterior chest flaps: a comprehensive strategy for multiple techniques. J Plast Reconstr Aesthet Surg 2013; 66 (08) 1074-1081
25 Heitmann C, Guerra A, Metzinger SW, Levin LS, Allen RJ. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg 2003; 51 (01) 23-29
26 Kim JT, Ng SW, Naidu S, Kim JD, Kim YH. Lateral thoracic perforator flap: additional perforator flap option from the lateral thoracic region. J Plast Reconstr Aesthet Surg 2011; 64 (12) 1596-1602
27 Kim JT. Two options for perforator flaps in the flank donor site: latissimus dorsi and thoracodorsal perforator flaps. Plast Reconstr Surg 2005; 115 (03) 755-763
28 Xie F, Li H, Li Q. , et al. Application of the expanded lateral thoracic pedicle flap in face and neck reconstruction. Burns 2013; 39 (06) 1257-1262
29 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40 (02) 113-141
30 Cordova A, D'Arpa S, Pirrello R, Brenner E, Jeschke J, Moschella F. Anatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap: the free supraclavicular transverse cervical artery perforator flap. Surg Radiol Anat 2009; 31 (02) 93-100
31 Ogawa R, Murakami M, Vinh VQ, Hyakusoku H. Clinical and anatomical study of superficial cervical artery flaps: retrospective study of reconstructions with 41 flaps and the feasibility of harvesting them as perforator flaps. Plast Reconstr Surg 2006; 118 (01) 95-101
32 Haas F, Weiglein A, Schwarzl F, Scharnagl E. The lower trapezius musculocutaneous flap from pedicled to free flap: anatomical basis and clinical applications based on the dorsal scapular artery. Plast Reconstr Surg 2004; 113 (06) 1580-1590
33 Dabernig J, Ong KO, McGowan R, Wiberg M, Payne AP, Hart AM. The anatomic and radiologic basis of the circumflex scapular artery perforator flap. Ann Plast Surg 2010; 64 (06) 784-788
34 Ono S, Ogawa R, Hayashi H, Takami Y, Kumita S, Hyakusoku H. Multidetector-row computed tomography (MDCT) analysis of the supra-fascial perforator directionality (SPD) of the occipital artery perforator (OAP). J Plast Reconstr Aesthet Surg 2010; 63 (10) 1602-1607
35 Ogawa R, Hyakusoku H, Murakami M, Gao JH. Clinical and basic research on occipito-cervico-dorsal flaps: including a study of the anatomical territories of dorsal trunk vessels. Plast Reconstr Surg 2004; 113 (07) 1923-1933
36 Cherry GW, Austad E, Pasyk K, McClatchey K, Rohrich RJ. Increased survival and vascularity of random-pattern skin flaps elevated in controlled, expanded skin. Plast Reconstr Surg 1983; 72 (05) 680-687
37 Xie F, Zhu H, Gu B, Zan T, Liu K, Li Q. Resurfacing severe facial burn scars: an algorithm based on three different types of prefabricated expanded flaps. J Reconstr Microsurg 2014; 30 (09) 627-634
38 Smit JM, Klein S, Werker PM. An overview of methods for vascular mapping in the planning of free flaps. J Plast Reconstr Aesthet Surg 2010; 63 (09) e674-e682
39 Li H, Du Z, Xie F, Zan T, Li Q. Local skin warming enhances color duplex imaging of cutaneous perforators. Ann Plast Surg 2015; 75 (01) 108-111
40 Su W, Lu L, Lazzeri D. , et al. Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning. Plast Reconstr Surg 2013; 131 (01) 80-93