Application of the Expanded Neck Flap for Face and Ear Reconstruction in Burn Patients: A Report on 2 Cases

Abstract

Reconstruction of auricular deformities and facial scars after burns is a challenging undertaking for surgeons. Excessive scar tissue, a poor blood supply and the paucity of available skin are all substantial difficulties that should be considered before the operation. Expanded neck flaps provide comparatively larger and thinner flaps for the simultaneous treatment of auricular deformities and facial scars in burn patients. In this article, the authors introduced the use of an expanded neck flap as coverage tissue for ear reconstruction and face resurfacing in 2 burn patients. The operation consisted of 3 stages. In the first stage, the expander was implanted subcutaneously under the skin of the neck to create adequate skin and soft tissue. In the second stage, the expander was removed, and the expanded flap was transferred to cover defects on the auricle and face. The third operation to repair the reconstructed ear and thick flap could be performed according the willingness of the patients and surgeons. Esthetically satisfactory results were achieved in both of the patients. The flaps survived completely, and the skin color, texture, and flexibility were well matched to those of the peripheral tissue. Six months postoperatively, the flaps did not shrink, and subsequent contractures did not recur. Both of the patients experienced high satisfaction, and no adverse effects were detected.

Creating a re-expanded prefabricated island flap constructed with an anastomosed vascular pedicle for burned ear reconstruction: a case report

“…Extensive scarring was also visible on the forearm and supraclavicular region. Therefore, previous successful cases of framework prelamination in the above areas could not be emulated (1)(2)(3). We also immediately disregarded the modified Brent-Nagata's methods combined with skin grafting because a previous surgical exploration had found that the superficial temporal artery had been destroyed, making it difficult for the temporoparietal fascial flap to survive.…”

“…After years of constant exploration, satisfactory burned ear reconstruction has been achieved by the combination of tissue expansion and distal composite framework prelamination followed by flap transfer to the defect location. The supraclavicular skin, neck skin, and medial forearm skin are the best alternative areas for the auricular framework prelamination for this process ( 1 - 3 ). When none of the above regions are available, using another area of hairless skin color matched to the periauricular area to cover the auricular framework may be possible, however, reports on this option are rare.…”

Parotid Fistulas after Reconstructive Surgery for the Face and Neck Burn Contracture

“…Although the split-thickness-skin graft is a standard method of wound coverage in acute burn, the grafted skin shrinks over time 2) , resulting in variety of functional and aesthetic losses. Although the estimation of the original thermal damage to deeper structures is difficult for reconstructive surgeons, within this context, contracture release followed by thicker skin grafting or flap coverage is the most common procedure of burn reconstruction in order to improve the patient's quality of life 3,4) .…”