ABSTRACT
Facial and cervical skin are prone to scar contracture due to extensibility and thin characteristic there. End points of scar contracture treatment in this area is to provide good texture and skin color which match with healthy peripheral skin and normal neck and mouth movement. Cervicofacial angle should be restored in every transferred flap as a major principle in aesthetic surgery. We assess cervicomandibular, cervicomental and infra auricular angles refinement while insetting flaps to treat chronic burn scar contractures. It is a prospective, descriptive study with 34 patients complaining of chronic burn scar contracture in Cervicofacial area that referred to 15 Khordad Hospital from 2004 to 2006. Designed flaps are basically as advancement, transposition and rotational, either random or axial flaps. Donor sites were expanded by tissue expander to inset the flaps after releasing scar contractures. We hatched the fibrous capsule underneath the flap and fixed it to mentum, mandibular body and ramus periosteium and platysma muscle in three rows in cervicomandibular angle to create impressive concavities there. Bulky non compressive dressing and drain were used in all cases. Mean age is [25.5 +/- 8.3] years and 29.4% patients are female and 70.6% are male. Lower facial scar in 24 patients, cervical scar in 8 patients, and Cervicofacial scar in 2 patients were observed. Ten patients had bilateral lower facial scars. Flame as the main etiology is observed in 47% of patients and boiling water in 26.5% of patients. The most popular flap is occipitocervico shoulder in 14 patients, and the second is occipitocervico pectoral in 12 patients based on occipital and supra clavicalar artery and pedicled axial flap based on transverse cervical artery in patients and as advancement flap in 8 patients. Advancement flaps were bilateral. The only observed complication is distal epidormolysis of flap which was managed conservatively in two cases. Postoperatively no blunting is considered at least in six months follow up. Cervicofacial angle refinement in flap transfer is an integral part of cosmetic operation in this area