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| COMMENTARY |
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| Year : 2013 | Volume
: 21
| Issue : 1 | Page : 48-49 |
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Post-burn neck contracture: Should the skin graft be banished
Ramesh K Sharma
Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| Date of Web Publication | 22-Nov-2013 |
Correspondence Address:
Ramesh K Sharma
Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-653X.121882
How to cite this article:
Sharma RK. Post-burn neck contracture: Should the skin graft be banished. Indian J Burns 2013;21:48-9 |
The management of post-burn neck contracture is a challenging task that can test the skills of the surgeon and the patience of the victim. However, if the basics of management are clearly understood, good function and aesthesis can be achieved irrespective of the resurfacing modalities chosen.
The commonest cause of unfavorable postoperative results in post-burn contracture neck is inadequate release due to incomplete treatment of scar tissue. The scar tissue should be addressed aggressively, preferably by excision so that no residual contracting forces are left in the bed. The platysma muscle needs special attention as its incorporation in scar can lead to secondary deformities because of its attachments to lower facial muscles around the mouth, especially depressor anguli oris.
The recipient bed may be visualized as having two components, the upper submental and the lower neck region and these can be resurfaced with two separate sheets of intermediate thickness split skin graft. This would result in better definition of the cervico-mental angle. The postoperative course entails use of a simple neck collar and massage with emollients for 3-6 months. Good functional and aesthetic results can be observed in patients with extensive neck contractures after one surgical intervention using skin graft for resurfacing. It is also important to keep in mind the compliance of the patient in the postoperative period. No matter how excellent the scar release and wound coverage, a non-compliant patient will end up with an unsatisfactory result if neck collars are not used as instructed and if the patient does not engage in stretching and range of motion exercises.
The problem with flaps whether free or pedicled is that the tissue does not drape well to the neck contours even after repeated thinnings. [1],[2],[3],[4] The medial ends of the sternomastoid muscle is an important highlight of the anterior and lateral neck and this important landmark gets masked with the use of flaps. Moreover the suprasternal notch is hidden by flaps. An excessive and bulky flap may hang like a dewlap in cattle.
In almost all cases shown by the author the cervicomental angle is rather blunt, the lateral and anterior definition of neck is masked and the suprasternal notch cannot be appreciated. These important aspects for obtaining a pleasing neck contour as suggested by Ellenbogen [5] can be achieved by use of skin grafts. [Figure 1] shows postoperative result in a child 3 years after just one surgery for extensive neck contracture.
While the free flaps may be a useful tool in resurfacing of large areas elsewhere in the body, these may not necessarily be ideally suited for burnt neck. The clarion call for a paradigm shift in management of post-burn neck contracture should be directed more to the adequate release, excision of scar and respecting the aesthetics of the neck. The choice of resurfacing modalities should be left to the individual surgeon, although one would hasten to reiterate that medium thickness skin graft has stood the test of time.{Figure 1}
| References | |  |
| 1. | Ninkovic M, Moser-Rumer A, Ninkovic M, Spanio S, Rainer C, Gurunluoglu R. Anterior neck reconstruction with pre-expanded free groin flaps and scapular flaps. Plast Reconstr Surg 2004;113:61-8. 
[PUBMED] |
| 2. | Karacaoglan N, Uysal A. Reconstruction of post burn scar contracture of the neck by expanded skin flap. Burns 1994;20:547-50.
[PUBMED] |
| 3. | Kuran I, Turan T, Sadikoglu B, Ozcan H. Treatment of neck burn contracture with a super thin occipito-cervico-dorsal flap: A case report. Burns 1999;25:88-92.
[PUBMED] |
| 4. | Yang JY, Tsai CF, Chana J, Chuang SS, Chang SY, Huang WC. Use of free thin anterolateral thigh flaps combined with cervicoplasty for reconstruction of post burn anterior cervical contractures. Plast Reconstr Surg 2000;110:39-46.
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| 5. | Ellenbogen R, Karlin JV. Visual criteria for success in restoring the youthful neck. Plast Reconstr Surg 1980;66:826-37.
[PUBMED] |
[Figure 1]IndianJBurns_2013_21_1_48_121882_f1.jpg
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