Post Burn Contracture of Lower Face and Neck, Cervicomental Reconstruction With Triangular Dermal Fat Flap: A New Approach
Abstract
Deformities of burn scars in the chin and upper neck are a tragedy for patients and pose a great challenge to plastic surgeons due to limited available methods for the reconstruction of three-dimensional appearance. In this paper, we present a new technique for the correction of cervicomental angle with a dermal fat flap. Fourteen patients ages 18 to 24-year-old with extensive neck deformities were enrolled in the study. During the operation, first, we deepithelialized a triangular scar area in the upper neck, then created a dermal fat flap and flip it up to the chin, restoring the chin shape and volume, after that for subsequent reconstruction of cervicomental angle, after releasing skin from lateral sides of the triangle defect, we approximated the AB and AC line to the upper edge of the defect by V-Y advancement. The remaining defect is covered with a full-thickness skin graft. In all cases, the chins were reshaped with a dermal fat flap. The mean cervicomental angle was 144+14.6° preoperatively, which was reduced to 108.9+6.15° postoperatively. The neck and chin were preserved with better contours. This is a new technique that has never been described before in the literature, and it is innovative compared to the traditional techniques. Good cosmetic outcomes make this technique preferable for all burn neck deformities with an obtunded cervicomental angle.
2. Mody NB, Bankar SS, Patil A. Post burn contracture neck: clinical profile and management. J Clin Diagn Res 2014;8:NC12-7.
3. Yashan Gao, Haizhou Li, Bin Gu, Feng Xie, Hainan Zhu, Zhichao Wang, et al. Postburn Neck Contracture: Principles of Reconstruction and a Treatment Algorithm. J Reconstr Microsurg 2018;34:514-21.
4. Hirsch R, Sadick N, Cohen JL. Aesthetic rejuvenation a regional approach. In: Hirsch R, Sadick N, Chapter6: Neck Rejuvenation,1st ed. New York: McGraw-Hill, 2009:123.
5. Ellenbogen R, Karlin JV. Visual criteria for success in restoring the youthful neck. Plast Reconstr Surg 1980;66:826-37.
6. Ninkovic M, Moser-Rumer A, Ninkovic M, Spanio S, Rainer C, Gurunluoglu R. Anterior neck reconstruction with pre-expanded free groin and scapular flaps. Plast Reconstr Surg 2004;113:61-8.
7. Grishkevich VM, Grishkevich M, Menzul V. Postburn neck anterior contracture treatment in children with scar-fascial local trapezoid flaps: a new approach. J Burn Care Res 2015;36:e112-9.
8. Grishkevich VM, Grishkevich M. Postburn neck lateral contracture anatomy and treatment: a new approach. J Burn Care Res 2015;36:e294-9.
9. Tan O, Atik B, Ergen D. A new method in the treatment of postburn scar contractures: double opposing V-Y-Z plasty. Burns 2006;32:499-503.
10. Emsen LM. A new method in the treatment of postburn and posttraumatic scar contractures: double opposing Z and V- (K-M-N) plasty. Can J Plast Surg 2010;18:e20-6. 2010.
11. Goverman J, Mathews K, Goldstein R, Holavanahalli R, Kowalske K, Esselman P, et al. Adult contractures in burn injury: a burn model system national database study. J Burn Care Res 2017;38:e328-36.
12. Tsai FC, Mardini S, Chen DJ, Yang JY, Hsieh MS. The classification and treatment algorithm for post-burn cervical contractures reconstructed with free flaps. Burns 2006;32:626-33.
13. Yang JY, Tsai FC, Chana JS, Chuang SS, Chang SY, Huang WC. Use of free thin anterolateral thigh flaps combined with cervicoplasty for reconstruction of postburn anterior cervical contractures. Plast Reconstr Surg 2002;110:39-46.
14. Donelan MB, Liao EC. Reconstruction of the head and neck. In: Herndon D, ed. Total Burn Care. 4th ed. Philadelphia, Pa.: Elsevier Saunders, 2012:597-615.
15. Rosenberg L, Lawrence JW. Psychosocial recovery and reintegration of patients with burn injuries. In: Herndon D, ed. Total Burn Care. 4th ed. Philadelphia, Pa.: Elsevier Saunders, 2012:750.
16. Ashab Yamin MR, Mozafari N, Mozafari M, Razi Z. Reconstructive surgery of extensive face and neck burn scars using tissue expanders. World J Plast Surg 2015;4:40-9.
17. Laredo Ortiz C, Valverde Carrasco A, Novo Torres A, Navarro Sempere L, Marquez Mendoza M. Supraclavicular bilobed fasciocutaneous flap for postburn cervical contractures. Burns 2007;33:770-5.
18. Margulis A, Agam K, Icekson M, Dotan L, Yanko-Arzi R, Neuman R. The expanded supraclavicular flap, prefabricated with thoracoacromial vessels, for reconstructionof postburn anterior cervical contractures. Plast Reconstr Surg 2007;119:2072-7.
19. Rashid M, Zia-Ul-Islam M, Sarwar SU, Bhatti AM. The ‘expansile’ supraclavicular artery flap for release of post-burn neck contractures. J Plast Reconstr Aesthet Surg 2006;59:1094-101.
20. Parrett BM, Pomahac B, Orgill DP, Pribaz JJ. The role of free-tissue transfer for head and neck burn reconstruction. Plast Reconstr Surg 2007;120:1871-8.
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Issue | Vol 59, No 5 (2021) | |
Section | Original Article(s) | |
DOI | https://doi.org/10.18502/acta.v59i5.6663 | |
Keywords | ||
Burns scar Neck Flaps |
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