Total Neck Anterior Scar Contracture: Anatomy and Treatment with Local Scar-Fascial Trapezoid Flaps

Abstract

One of the consequences of neck burns is neck scar deformity and contracture. Cervical contracture in children leads to functional impairment and has a profound psychological impact on the child; it inhibits mandibular growth, deforms the face, and creates kyphosis; therefore, early surgical reconstruction is indicated. Skin grafting has a higher rate of contracture recurrence; in these cases, a flap seems to provide a durable solution. Despite the existence of multiple neck reconstruction methods, successful neck contracture elimination remains a challenge for surgeons. A complete neck reconstruction aims to: (1) eliminate the contracture and (2) restore the neck’s skin by using pedicle (expanded and not expanded) or free flaps.

There are cases, however, when it is simply impossible to complete both tasks simultaneously. For these patients, contracture elimination using local tissues appears to be a sufficient and satisfactory solution. Because triangular flap plasty methods do not allow for complete elimination of severe and moderate neck contractures, the authors propose reconstruction using scar-fascial trapezoid flaps. The flaps and reconstructive trapeze-flap technique are found to be reliable and successful; this procedure allows for scar contracture release and neck contour restoration by the local tissues.