ABSTRACT
BACKGROUND: It has been established that patients with burn sequelae of the anterior neck and chest have a significant degree of flap descent and deficit in neck extension when resurfaced with a single free flap. A protocol was developed to avoid flap descent in these patients by resurfacing the neck with multiple free flaps. The purpose of this article is to present our protocol for treatment and long-term results of this technique. METHODS: Twenty-five 25 patients with burn sequelae of the anterior neck and anterior thorax were retrospectively identified. Ten patients were treated with a single free flap (group 1), and 15 patients were treated with multiple free flaps (group 2). Patients were followed up for an average of 7 years after their definitive reconstructive procedure at which time measurements including flap descent from sternal notch, deficit of neck extension, and subjective reports of discomfort were obtained. RESULTS: Patients in group 1 demonstrated 8 cm (interquartile range [IQR], 1.75 cm) of flap descent, whereas patients in group 2 demonstrated 0.5 cm (IQR, 0 cm) of flap descent. Patients in group 1 demonstrated 12.5 degrees (IQR, 10 degrees) of deficit in neck extension, whereas patients in group 2 demonstrated 0 degrees (IQR, 0 degrees) of deficit in neck extension. Analysis demonstrated significantly greater descent and deficit in neck extension in group 1 compared with group 2. CONCLUSIONS: Patients with burn sequelae of the neck and anterior chest experience less flap descent and deficits in neck extension when resurfaced with multiple free flaps.
Subject(s)
Burns , Free Tissue Flaps , Plastic Surgery Procedures , Thoracic Wall , Burns/complications , Burns/surgery , Humans , Neck/surgery , Plastic Surgery Procedures/methods , Retrospective Studies , Thoracic Wall/surgeryABSTRACT
BACKGROUND: Burn sequelae involving the anterior neck and thorax produce a difficult challenge for reconstruction because contracture of anterior thoracic burns in addition to functional movement of the chest wall can result in downward displacement of the neck unit. The purpose of this study was to understand the influence of burn sequelae of the anterior thorax on anterior neck flap descent, function, and aesthetics. METHODS: Ten patients with burn sequelae of only the anterior neck (group 1) and 10 additional patients with burn sequelae of the anterior neck and thorax (group 2) were retrospectively identified. All 20 patients were treated with scar release and a single extended circumflex scapular free flap for neck resurfacing. Patients were followed for an average of 10 years, at which time flap descent from the sternal notch, deficit of neck extension, and subjective reports of discomfort were measured. RESULTS: Patients in group 1 experienced a median flap descent of 0 [interquartile range (IQR), 1.62 cm] and a median deficit of 0° (IQR, 5°) during neck extension. Patients in group 2 experienced a median flap descent of 8 cm (IQR, 1.75 cm) and a median deficit of 12.5° (IQR, 10°) during neck extension. Retrospective analysis of the 10 patients with burn sequelae of the anterior neck and thorax (group 2) demonstrated a significantly greater degree of flap descent and deficit of neck extension compared with the 10 patients with burn sequelae of only the anterior neck (group 1). Patients in group 1 also subjectively reported less discomfort at follow-up compared with patients in group 2. CONCLUSIONS: We conclude that patients with burn sequelae involving the anterior neck and thorax have a significantly greater degree of flap descent and neck extension compared with patients with burn sequelae involving only the anterior neck. Flaps of a larger surface area or use of multiple flaps for neck resurfacing may be considered to avoid significant flap descent associated with burn sequelae involving both the anterior neck and thorax.