Surgical management for mentosternal contractures by flap procedures

Abstract

Abstract.Mentosternal contractures still represent a surgical challenge due to their prominent position. They require early operative treatment for both function and aesthetic reasons. Careful clinical examination of scar position and traction forces, both at rest and when functioning, in addition to proper evaluation of the surrounding soft tissue are mandatory for precise preoperative planning of the required reconstruction. In general, the technically most feasible operation is favored if the functional and aesthetic results are good and postoperative risk for recurrence is low. Between 1987 and 1994, 21 patients with cervical, mentosternal, and mentothoracic contractures were operated upon. Eight patients were reconstructed with local flaps and 13 with microvascular free flaps. Key words:Mentosternal contractures -Surgical reconstruction -Conventional and microsurgical methods since the neighboring tissues are often involved and local procedures will not be successful.Mentosternal contractures are divided into four categories [1]: a small contracture is defined as an isolated scar involving less than one-third of the ventral neck. A medium contracture is in the range of one and twothirds, and a big contracture represents more than twothirds of the ventral neck. An extensive contracture includes additional mentosternal adhesions.To plan the operation the surgeon must be aware of the three-dimensional nature of the scar, this also includes the texture of the wound bed and involvement of functional structures such as platysma, cervical fascia, muscles nerves, blood vessels, and the trachea. In general, the most technically feasible operation is favored, if the functional and aesthetic results are good and postoperative risk for recurrent mentostemal contracture is low [15].The problem, i.e., which operative technique to employ, will be illustrated by several clinical cases.Mentosternal contractures result most often from burns, scalds, and injuries with acid or lye. The cervical region is designed to allow a maximum range of three-dimensional motion. It is also extremely important aesthetically. Any vertical scar contractures in this region will pull the cheeks and lower lips caudally. This causes incomplete mouth closure and cicatricial ectropion as well as tracheal changes affecting respiration and distortion of the cervical spine [13]. These contractures cause the disfigured patient significant functional and aesthetic problems and early operative correction is recommended.Before choosing the appropriate operative procedure a thorough assessment of the position and the extent of the scar must be carried out. Evaluation of the surrounding anatomy is mandatory for precise operative planning Patients and methodsBetween 1987 and 1994, 21 patients (16 male and 5 female ranging between 8 and 46 years of age) with mentosternal contractures underwent operative treatment. Eight patients had a local flap procedure, these included three expanded skin flaps, three fasciocutaneous cervicohumeral flaps, and two myocutaneo...