Pre-expanded cervico-acromial fasciocutaneous flap based on the supraclavicular artery for resurfacing post-burn neck scar contractures

Cervical Defect Reconstruction Using Preexpanded Neck Flaps Transferred in a Scarf-wrapping Manner

OBJECTIVE

Cervical burn scar contractures can be repaired using many modalities, including skin grafts, pedicled and free flaps. Although preexpanded cervical flaps can provide a like-with-like reconstruction, a simple advancement transfer of the flaps often fails to achieve ideal outcomes. The authors aimed to introduce a method using the preexpanded cervical flaps transferred in a scarf-wrapping manner to repair neck defects.

METHODS

The surgery was divided into 2 stages. In the first stage of the surgery, an expander was implanted above the platysma muscle on each side of the neck. After adequate inflation of the expanders, second-stage operations commenced. Following the expander removal, one flap was rotated upward to repair the neck defect, whereas the other flap was rotated downward to repair the neck defect and close the donor site of the first flap. Data on patient demographics, clinical characteristics, and outcomes were also collected.

RESULTS

Between July 2004 and May 2024, 24 patients underwent neck reconstructions using this method. Four patients had grade I cervical contractures, and 20 had grade II. The mean size of the defects was 15.62×5.75 cm (range: 6×6-18×10 cm). The average dimension of the neck flap was 15.02×7.65 cm (range: 9×6-20×10 cm). All the flaps survived with no perfusion-related complications. The average improvement in the cervico-mental angle was 29.25 degrees (range: 10-45 degrees). Postsurgery follow-up ranged from 4 to 155 months (mean: 22 mo). All patients and their families were satisfied with the outcomes.

CONCLUSIONS

Preexpanded cervical flaps transferred in a scarf-wrapping manner can be used to reconstruct grade I and II cervical scar contractures and provide a like-with-like reconstruction of the neck.

Reconstruction of Soft Tissue Defects on the Face, Neck, and Chest by Expanded Cervico-Acromial Flap

BACKGROUND

Repairing the defects of face and neck remains a big challenge for plastic surgeons. Here we present a case series of pre-expanded cervico-acromial flaps in the repair of soft tissue defects.

METHOD

This is a retrospective study that a total of 126 patients between 2001 and 2019 were included. One patient was excluded since he did not complete the treatment. All patients were followed for at least 0.5 years (range: 0.5-4 years, mean 2.50 years) after surgery.

RESULTS

All patients are satisfied with the appearance. The color and texture of expanded flaps were similar to surroundings. One patient (0.8%) had complete necrosis and received skin grafts. The size of cervico-acromial was 26-10 × 14-6 cm (mean, 15.389 ± 2.701× 8.341 ± 1.075 cm). The time of operation during stage 1 was 59.254 ± 9.895 minutes, 96.912 ± 18.936 minutes during stage 2, and 38.146 ± 9.478 minutes during stage 3. Surgical complication rate was 14.3%, given that 18 patients had complications following the surgery.

CONCLUSIONS

The cercico-acromial flap is a reliable and multifunctional method for face, neck, and chest reconstruction.

Supraclavicular Flap for Severe Post-burn Neck Contracture in Children

The neck is essential and vital for all head movements and performing daily functional activities. The second-degree deep dermal and full-thickness burns causing anterior neck contracture restricts movement and if untreated develop deformities, in the oral cavity, eyes, posture, and chin growth and development, especially in children. Neck contracture results in kyphoscoliosis, lower lip seal resulting in impaired vision, balance, swallowing, feeding, and speech as well as social stigma, depression, and embarrassment. The treatment for post-burn anterior neck contractures is contracture release and reconstruction with skin grafts (split and full-thickness), axial pattern flaps, perforator propeller flaps, microvascular free flaps, tissue expansion, prefabrications, and skin substitutes. In addition to functional and esthetic recovery, post-surgery social and vocational rehabilitation is essential for children. We report a ten-year-old boy with severe anterior neck post-burn contracture managed with unilateral supraclavicular flap and residual areas with a split-thickness skin graft.

Complications of tissue expansion in the head and neck

BACKGROUND

The authors aim to present a comprehensive review detailing the present state of evidence with regard to complications following tissue expansion in the head and neck.

METHODS

A systematic literature search was conducted to identify all studies reporting complications of tissue expansion in the head and neck between 2000 and 2019. Subgroup comparisons based on expander locations and planes were conducted.

RESULTS

A total of 7058 patients were included. Tissue expansion was associated with an overall complication rate of 8.73% (616/7058). The most common complications were extrusion (207/7009; 3.0%) and hematoma (200/7009; 2.9%). Overall complications were highest in the scalp (65/238; 27.3%) and lowest in the mastoid (347/5688; 6.1%). Complications were more common with expansion in the non-subcutaneous plane (63/590; 10.7%).

CONCLUSION

In the absence of large clinical trials, systematic reviews such as these can help inform clinical guidelines and provide practitioners with an evidence-based reference to improve informed consent.

Tissue expansion reconstruction of head and neck burn injuries in paediatric patients - A systematic review

Tissue expansion reconstruction in clinical practice has existed for over half a century. The technique was initially used for breast reconstruction but later found its use in reconstruction of excisional defects resulting from a variety of causes including surgery for post-burn/post-traumatic deformities, congenital giant naevi, skin cancer, etc. It offers an improved matching of skin colour and texture, and avoids the high infrastructure requirements of microsurgery for free flap transfers. We present a systematic literature review of 35 worldwide English language articles with representative cases of paediatric tissue expansion reconstruction of burn injuries of the head and neck. The review identified 68 children of an average age of 11.3 years. The most common burn aetiology was flame burn injury. The average area to be reconstructed was of 206 cm2 and patients went through expansion processes for an average of 99.7 days. Three articles included cases in which patients had more than one expansion session. Supportive techniques provide examples of developments in the area of tissue expansion reconstruction such as self-inflating expanders and endoscopic approaches. Further studies focussing on particular indications, age groups and anatomical locations of tissues to be expanded are required in order to improve the understanding of this technique's limitations and continue its development.

The neck burn scar contracture: a concept of effective treatment

A neck scar contracture can severely and negatively affect the function of mastication, phonic, or breathing and result in neck pain and issues with esthetics. The best way is of course to avoid such contracture by means of non-surgical treatment such as use of a growth factor. The basic fibroblastic growth factor is clinically well proven in decreasing scar formation and improving healing. There are numerous reconstructive methods for neck contracture, especially when the lesions are relatively limited in part of the neck. However, a very severe and full circumferential scar contracture requires extensive reconstruction. The thin groin flap is one of the answers and well matches with the tissue texture and maintains the flexibility. Even with extensive burns and delayed reconstructions due to resuscitation first, the groin area is well preserved and can be safely harvested by dual vasculature systems of the superficial circumflex iliac artery and superficial epigastric artery, which warrant more reliability compared to the perforator flaps in this area. More demanding and stringent forms of the neck burn scar contracture are the sequelae of radiation. A radiation burn or radiation injury can be progressing and hard to heal. Adipose-derived stem cells can reverse the scar contracture as the surrounding tissue is softened and can accelerate wound healing. In this review, different types of neck burn scar contracture and reconstructive methods are summarized, including innovative use of bFGF and ADSCs in the management of difficult wound healing and scar contracture.

Pre-expanded Supraclavicular Artery Perforator Flap

The supraclavicular artery perforator (SAP) flap is a versatile flap for the reconstruction of head and neck defects. Recently, the authors have modified the SAP flap by using an anterior branch of the transverse cervical artery. The anterior SAP flap allows the harvest of a tissue island in the deltopectoral fossa, which is even thinner, is more pliable, and shows a superior color match to the face and neck compared with the original SAP flap. Pre-expansion increases flap size considerably, enabling the coverage of extended defects without the need of microsurgery.