Postburn Reconstruction of the Face and Neck

Abstract

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the cardinal principles in the management of postburn deformities in the face and neck. 2. Understand reconstruction of specific subsites in the face and neck affected by burn contracture. 3. Acquire knowledge about the various techniques of burn reconstruction of the face and neck. 4. Grasp technical nuances and select appropriate surgical options for individual cases. Summary: Postburn contractures in the face and neck region are multifactorial in origin and difficult to prevent in extensive burns. Facial burns lead to distortion of anatomical landmarks, causing aesthetic, functional, and psychological problems. Each subunit of the face is unique in structure; thus, the surgeon needs to adjust the timing of surgery and the technique according to region and the severity of contracture. Contracture of one unit, especially that of the neck and forehead, can exaggerate the contracture in neighboring subunits. The role of these extrinsic influences must be considered while sequencing surgical procedures. The burn surgeon must be adept in all reconstructive surgery techniques from skin grafting to tissue expanders to microsurgery to obtain the best outcomes. Surgery must be followed up with long-term physical therapy and psychological rehabilitation to help burn survivors with head and neck contractures to integrate back into society.

The Development and Management of Neck Burn Scar Contracture Recurrence

“…Neck contractures after burn injury have both a high incidence and poor outcomes due to the comparatively thin and mobile skin at the neck, making it more susceptible to deep burn and consequent scar contracture. 10 The aesthetic and functional outcomes associated with postburn neck contracture have led to recent studies examining the epidemiology and predictors of developing a contracture. 9,14 To the best of our knowledge, this is the first study attempting to describe neck CR in burns.…”

“…Recovery after traumatic burn injury can be a lengthy process, whereby patients may need to undergo multiple reconstructive surgeries to restore function and quality of life. Neck contractures after burn injury have both a high incidence and poor outcomes due to the comparatively thin and mobile skin at the neck, making it more susceptible to deep burn and consequent scar contracture 10 . The aesthetic and functional outcomes associated with postburn neck contracture have led to recent studies examining the epidemiology and predictors of developing a contracture 9,14 .…”

“…9 The mobility and laxity of the skin covering the neck make it more susceptible to contraction due to less resistance to the tensile forces. 10 In fact, after burn injury, the neck was determined to be the area with the most limited range of motion due to wound contractures. 11 The management and treatment of neck scar contractures are challenging because of the delicate anatomy of the region and critical functional junction.…”

“…The neck has the highest incidence and poorest burn scar contraction outcomes, due to the region being thin and mobile 9 . The mobility and laxity of the skin covering the neck make it more susceptible to contraction due to less resistance to the tensile forces 10 . In fact, after burn injury, the neck was determined to be the area with the most limited range of motion due to wound contractures 11 …”

Occipito-Cervico-Dorsal Flap for Neck Reconstruction After Postburn Contractures: A Case Report and Literature Review

“…Releasing an immature scar may result in excessive bleeding and further inflammation and contraction, with consequent poor graft adherence and recurrence of the contracture. Therefore, except in some special cases involving severe ectropion of the eyelids, microstomia, or infected hypertrophic scars and abscesses, plastic surgeons should wait at least 1 year after the burn before performing surgical reconstruction of the face and neck (Hayashida & Akita, 2017; Sabapathy et al., 2022).…”