Superior extension of the parascapular free flap for cervical burn scar contracture

Post-transfer flap expansion for management of severe post-burn contraction neck

We report a case of a 35-year-old woman who presented with post-burn neck scar contracture with massive scarring of the neck and lower face. The initial step was to release the contracture with excision of the scar tissue together with coverage of the resultant defect with a latissmus dorsi musculocutaneous flap. Six months later, we implanted a round tissue expander underneath the flap with steady cautious expansion over the following 7 months to almost double the original flap dimensions to achieve an additional replacement of the scar tissue over the upper neck and lower face.

Penile reconstruction by the free scapular flap and malleable penis prosthesis

BACKGROUND

: Penile reconstruction has always been a challenging problem for plastic surgeons while facing patients with severe congenital deformities and gender dysphoria and those who have suffered penile loss because of trauma, self-amputation, malignancy, and so on. Since 1936, when Bogoras first constructed a total penis, attempts have been made by different techniques, including skin flaps or myocutaneous flaps. And with development of free tissue transfer and microsurgical techniques, various free skin flaps, such as the radial free forearm flap, the superficial inferior epigastric artery flap, the superficial circumflex iliac artery flap, have been attempted for phallic construction, with the goal of functional (including a competent neourethra that allows voiding while standing and sexual intercourse) and cosmetic result. The purpose of our study was to evaluate the scapular free flap and implantation of malleable penile prosthesis for penile reconstruction.

PATIENTS AND METHODS

: Since March 2000, 20 patients with penile loss were reconstructed in a 1-stage procedure by transferring scapular flap and implantation of a malleable penile prosthesis. The age of the patients ranged between 21 and 36 years old. Of these patients, 12 had penile amputation resulting from an electric accident; the other 8 were self-amputated.

RESULTS

: All the flaps remained 100% viable postoperatively. Follow-up ranged from 1 to 5 years. There were no cases of urethral fistula, urethral stenosis, prosthesis extrusion, or infection. The reconstructed penis yielded satisfactory function and esthetic appearance.

CONCLUSION

: The scapular free flap is an ideal flap that achieves satisfactory function and esthetic appearance for penile reconstruction because of its adequate amount of tissue, reliable vascularity, acceptable donor-site morbidity, and reliable blood supply.

Microsurgical combined scapular/parascapular flap for reconstruction of severe neck contracture: case report and literature review

OBJECTIVE

The reconstruction for severe neck contracture is difficult, because it may include not only the necessity the use of a large flap but also the ability for three-dimensional movement of the neck.

METHODS

A 41-year-old woman sustained a severe neck contracture with retraction of the lower lip and limited range of neck motion after a chemical burn. We used the combined scapular/parascapular flap to reconstruct the soft-tissue defect in the neck after excision of hypertrophic scar and release of contracture. The scapular portion was transferred to cover the defect vertically, and the parascapular portion was transferred to cover the transverse portion of the neck. This kind of design would allow the patient to move her neck more easily.

RESULTS

Postoperatively, the range of motion of the neck was full in the vertical and horizontal directions after 6 months of rehabilitation. Also, the patient was satisfied with the final aesthetic results.

CONCLUSION

The microsurgical combined scapular/parascapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during surgery, is a good option for reconstruction of the severe neck contracture. We classify the inset of the combined scapular/parascapular flap into three types with six subtypes, according to the location of defects and the relation of the parascapular flap to the scapular flap.

Treatment of a neck burn contracture with a super-thin occipito-cervico-dorsal flap: a case report

Postburn neck contractures still represent a surgical challenge due to their exposed location; and early operative treatment is necessary for both functional as well as aesthetic reasons. An excellent functional result was obtained by using a supercharged super-thin occipito-cervico-dorsal flap described by Hyakusoku to repair a large defect of the anterior neck following a very wide neck burn contracture release. In this case report, the technique and its advantages among the other reconstructive modalities are discussed briefly.

The role of pre-expanded free flaps in revision of burn scarring

The authors present two patients affected by scars resulting from burning of over 60 per cent of the total body area, in which the pre-expansion of a free flap has been used to increase the tissue surface useful for transfer from the only area of residual healthy skin (left forearm, left parascapular region). In both cases it was possible to transfer abundant healthy tissue into the desired areas, obtaining a rapid release of the region, which made possible an early physical rehabilitation of the patient starting after the second postoperative week. One of the main problems encountered, when facing surgical rehabilitation for the seriously burned patient, is the poor availability of skin donor areas suitable for reconstructive flaps. The pre-expansion of free flaps provides an advantage in that it allows the few integral residual areas to be used, improving vascularization and therefore increasing the available surface. Furthermore, as pre-expansion reduces tension on the margins, it allows for the easier closing of the donor area, with a minor risk of complications and a better scar outcome.