Postburn Neck Anterior Contracture Treatment in Children With Scar-Fascial Local Trapezoid Flaps

Abstract

One of the dramatic consequences of burns is scar contracture and deformities of the neck. Cervical contracture in children is especially dangerous, leading to face disfigurement and kyphosis; therefore, early reconstruction is indicated. Despite the existence of many various surgical techniques, the successful neck contracture treatment in pediatric patients remains a challenge for surgeons. Eleven children (aged 5 to 14 years) with postburn neck anterior contractures were studied to develop a new approach for reconstruction that would employ the use of local scar-fascial flaps. The new approach and technique for postburn pediatric contracture treatment was developed which is especially effective in the treatment of children who cannot undergo complex and long surgical procedures that are aimed at both contracture elimination and neck skin restoration. The technique consists of two trapezoid scar-fascial flaps mobilization which includes all the anterior neck surfaces and consists of scars, fat layer, platysma, and deep cervical fascia. Counter transposition of flaps with tension elongated neck anterior surface was 100 to 200%. The contracture was fully eliminated, and neck contours, mentocervical angle, and head movement were restored. In case of severe contracture, residual wound in submandibular region and above clavicles were skin-grafted. The full range of head motion (functional results) was achieved in all the 11 patients. The flaps continued to grow and the skin grafts shrinkage was moderate. Local trapeze-flap plasty allows neck contracture elimination in children in the cases when a more complex technique is impossible or undesirable to use. Early surgical intervention prevents secondary complications, allotting enough time for patients to mature and be ready for more complex procedures.

Clinical Kinesiology and Posturology Applied to a Group of Italian Students. A Morphological Observational Study.

“…Moreover, good condition of the skin is a symptom of physical wellness and proper nutrition. Authors showed how the presence of post burn scars causes a lateral cervical flexion contracture [11]. In our study the observation of the classrooms provided relatively negative results, since the percentage of students with a correct posture was low (data not shown).…”

The neck burn scar contracture: a concept of effective treatment

“…In the severe neck contractures, many reconstructive options are proposed including local [1, 2, 4–7] and free flaps [24] and combination with tissue expansion. However, in very severe cases, the donor sites can be hardly found.…”

“…In a series of 11 cases, age 5 to 14 years, post-burn anterior neck contractures were reviewed in an attempt to develop a new approach for reconstruction with local scar-fascial flaps [1]. …”

Boyun defektlerinin preekspanse oksipito-serviko-dorsal ada flepleri ile onarımı

“…Hypertrophic scars and keloids of the neck occur especially after burns. These lesions can lead to head and neck function restrictions such as; decreased neck rotation, cervical intervertebral joint and spine problems, oral competence and speech difficulties etc 7,8 . Neck scars may also cause social withdrawal symptoms.…”