Supraclavicular Flap for Severe Post-burn Neck Contracture in Children

Jerome, Terrence Jose; Sabtharishi, Vanathi; Sk, Thirumagal

doi:10.7759/cureus.12910

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…Different free tissue transfers have been described for the correction of cervical burn contractures. These consist mostly of fasciocutaneous flaps such as radial forearm, groin flaps [12], anterolateral thigh flaps [13,14], scapular flaps and thoracodorsal artery perforator flaps [15]. As discussed by Duteille et al, fasciocutaneous flaps from the anterior part of the body, as described in this series, are preferable because of their pliability, and they facilitate better positioning for the two-team approach [16].…”

Section: Discussionmentioning

confidence: 98%

Free Tissue Transfer in the Reconstruction of Neck Contractures after Burn Injury: A Case Series

Ferland-Caron

Kwan

Tredget

2023

EBJ

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Background: Recent advances in burn care have significantly improved the survival rate of patients with extensive burn injuries, placing greater emphasis on reconstruction to improve the long-term outcomes of scar deformities. Anterior and lateral neck contractures are common after burn injuries; they limit range of motion, complicate airway management and create significant cosmetic deformities. Traditional methods have been used to release contractures and improve function. However, they are subject to variable results, residual neck tightness, recurrence and suboptimal cosmetic appearance. Microvascular free tissue transfer is a more technically challenging and time-consuming method, but it offers the potential to overcome the long-term limitations of simpler options. In this paper, we present our experience with microvascular free flaps for the release of burn scar contractures of the neck as a potential high-quality permanent solution. Methods: Over a 10-year period, nine free flaps were performed on burn patients with total body surface area (TBSA) burns between 20 and 70%, who developed moderate to severe neck contractures. Four anterolateral thigh (ALT) flaps, four radial forearm free flaps (RFFFs) and one ulnar forearm flap were used to release neck contractures. Results: All nine flaps were completed successfully with significant improvement in the neck’s range of motion. Good aesthetic results were achieved with smooth contour and thin coverage. Overall, the patients were satisfied. However, five out of nine cases required at least one secondary procedure for flap defatting to reach optimal results. Conclusion: Post-burn scar contractures of the cervical region compromise the cosmetic appearance and airway security of recovering burn patients, imposing a significant impact on their psychological and functional quality of life. Consequently, cervical contractures can be prioritized when planning reconstruction for burn patients. Free flaps can be considered an important and reliable method of reconstruction for neck contracture deformity following burn injuries.

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Section: Discussionmentioning

confidence: 98%

Free Tissue Transfer in the Reconstruction of Neck Contractures after Burn Injury: A Case Series

Ferland-Caron

Kwan

Tredget

2023

EBJ

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“…Indeed, in addition to aesthetic and psychological aspects, neck contractures may cause severe functional limitations, such as dysphagia, abnormal speech, respiratory difficulty, and, in more severe cases, even restriction of the visual field. [5][6][7] Scar contracture formation after a burn trauma is a complex interplay of cellular, inflammatory, and extracellular mechanisms. After the deposition of collagen during the proliferative phase of wound healing, fibroblasts differentiate into myofibroblasts, which are responsible for the tightening and contractile activity, leading to physical deformity, adhesion, and distortion of anatomical structures.…”

mentioning

confidence: 99%

“…Of all body areas, postburn contractures to the neck are considered among those with a more profound impact on patients' quality of life. Indeed, in addition to aesthetic and psychological aspects, neck contractures may cause severe functional limitations, such as dysphagia, abnormal speech, respiratory difficulty, and, in more severe cases, even restriction of the visual field 5–7 …”

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confidence: 99%

The Development and Management of Neck Burn Scar Contracture Recurrence

Jeong,

Alessandri-Bonetti,

Pandya

et al. 2024

Ann Plast Surg

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Introduction Burn neck contractures pose a great challenge for reconstructive surgeons. A paucity of literature exist regarding long-term outcomes based on different surgical management strategies. The aim of this study was to evaluate the long-term outcomes of the treatment of neck burn scar contractures and evaluate surgical strategies according to their long-term effectiveness and associated complications. Methods A retrospective cohort study was conducted to review outcomes of neck contractures release after burn injury. All patients operated on between January 2009 and February 2023 at a single institution were included. Results A total of 20 patients developed neck burn scar contracture and were included in this study. The mean age was 32.9 ± 20.3 years. The burn injuries were most commonly thermal (n = 19, 95%). All burn injuries were full-thickness burns, with an average neck defect size of 130.5 ± 106.0 cm2. Overall, 45 surgical scar release procedures were performed on the 20 patients who developed a neck contracture. Patients underwent 1.65 ± 1.04 surgeries on average to address neck contracture. Although 25% of patients only received 1 surgery to treat neck contracture, some patients underwent as many as 8 surgeries. Contracture recurrence (CR) was the most common complication and occurred in 28.9% of the cases. The mean percentage total body surface area did not significantly differ in CR patients (26.7% ± 14.9%) and no-CR patients (44.5% ± 30.2%). However, there was a significant difference (P = 0.01) in the average neck defect size between CR patients (198.5 ± 108.3 cm2) and no-CR patients (81.1 ± 75.1 cm2). Conclusions This study showed that risk factors for initial burn scar contractures may differ from those associated with CR, highlighting the importance of neck defect size as a predictor. The study also examines various surgical approaches, with Z-plasty showing promise for managing CR. However, the absence of data on neck range of motion is a limitation. This research underscores the complexity of managing CR and emphasizes the need for ongoing postoperative monitoring.

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Synchronic basal skin cancer: resection and double full-thickness dermoepidermal graft in a comorbid patient. complex to simple

Ricciardi V,

Avariano,

Infante

et al. 2024

IJFCM

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Using skin flaps and grafts is a well-established and reliable method for skin reconstruction in plastic surgery. Although the surgical technique has been used for several decades, the basic principles remain similar. Factors such as skin thickness, color, and texture, the pattern of sun exposure, and adnexal quality should be considered when selecting the appropriate donor site. Objective: Report a double full-thickness dermoepidermal graft as a reconstructive alternative in a comorbid patient instead of using local flaps. Clinical case: 80 years old comorbid male patient with a synchronic (scalp and frontal) morfeiform basal skin cancer who was taken under local anesthesia to perform an oncological resection and a double supraclavicular full-thickness dermoepidermal graft. Satisfactory evolution, well integrated double graft, adequate oncological management and acceptable aesthetic result. Conclusion: Soft tissue reconstruction is performed according to the size and depth of the wound. If the pericranium is viable split-thickness skin grafts can be used for quick and simple reconstruction, but the first choice for reconstruction is usually local scalp tissue. However, in cases like these one, when a comorbid patient can have cardiovascular complications at the operation room, the full-thickness graft under local anesthesia are quickly and less risk reconstructive option. Besides, lateral forehead defects can be managed with a skin graft alone over an intact pericranium. Finally, after 1cm margins resection in a morfeiform basal skin cancer, soft tissue coverage with several options like skin graft are acceptable.

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Supraclavicular Flap for Severe Post-burn Neck Contracture in Children

Cited by 4 publications

References 22 publications

Free Tissue Transfer in the Reconstruction of Neck Contractures after Burn Injury: A Case Series

Free Tissue Transfer in the Reconstruction of Neck Contractures after Burn Injury: A Case Series

The Development and Management of Neck Burn Scar Contracture Recurrence

Synchronic basal skin cancer: resection and double full-thickness dermoepidermal graft in a comorbid patient. complex to simple

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