Reconstruction of postburn neck contractures using free thin thoracodorsal artery perforator flaps with cervicoplasty.
BACKGROUND
Severe postburn neck contractures are devastating functional and cosmetic deformities. The ideal material for coverage of defects created by neck contracture release is thin, supple, large, well-vascularized, healthy tissue. The thoracodorsal artery perforator flap, a workhorse flap for reconstruction, allows a large dimension and free thickness control with low donor-site morbidity. The value of a free thin thoracodorsal artery perforator flap for anterior neck burn deformities has not been evaluated in a substantial series.


METHODS
Four men and eight women underwent neck reconstruction from December of 2002 to August of 2004. Mean patient age was 34.3 years (range, 21 to 47 years). Thorough burn scar contracture releases were performed and cervicoplasty was added for optimal neck appearance. Uniformly thin thoracodorsal artery perforator flaps were made. Both lateral ends of these flaps were designed with a fishtail shape for sufficient release and to minimize linear scar band formation in the most lateral region of the neck.


RESULTS
Elevated flaps as large as 24 x 12 cm and with a mean thickness 5.3 mm were used. All flaps survived without significant complications. Range of neck motion increased, and the cervicomandibular angle was sharpened in all patients. A highly natural neck contour was universally obtained without a secondary debulking procedure.


CONCLUSIONS
The free thin thoracodorsal artery perforator flap with cervicoplasty provides good functional and aesthetic results in terms of neck contour and cervicomental angle, with a reduced necessity for secondary procedures and low donor-site morbidity. This method is highly valuable for reconstruction of severe postburn neck contractures.
Mun
Goo-Hyun
GH
Seoul, Korea From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Jeon
Byeng-June
BJ
Lim
So-Young
SY
Hyon
Won-Sok
WS
Bang
Sa-Ik
SI
Oh
Kap-Sung
KS
D000328:Adult; D001158:Arteries; D002056:Burns / Q000150:complications* / Q000601:surgery*; D044964:Cervicoplasty / Q000379:methods*; D003286:Contracture / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications* / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*