title: Treatment modalities in severe mento-sternal synechia.
abstract: OBJECTIVE
  Scar contracture of the neck after a burn-injury can cause both functional and aesthetic problems, and still presents a challenge for plastic surgeons. The anatomic area and adjacent structures such as the lower lip, trachea and neuro-vascular structures which are affected by the scar make treatment diffucult. Scarring and contracture of the neck region may severely limit function, cause alterations of normal posture and make intubation for surgery difficult. When a burn scar extends toward the face, eating and swallowing may be restricted and facial distortion may develop as the scar pulls the mouthdownwards even the lower eyelids.
  
  
  METHODS
  Following the upper extremity, the neck is the most common site affected by burn contracture. The method chosen for contracture release, depends on the severity of scarring and extent of involvement. If the contracture area is limited, z-plasties, skin grafts or local skin flaps are adequate for the treatment but when the whole anterior neck is affected, the treatment modalities are limited and mostly skin grafts either meshed or unmeshed are used.
  
  
  RESULTS
  In this study we evaluated the usage of alternative teatment methods involving skin grafts and local flaps for severe neck contractures and tried to discuss oftenly encounered difficulties in treating these group of patients.
  
  
  CONCLUSIONS
  Many techniques have been described for correction of neck contractures, including skin grafting, expanders, local regional flaps and free flaps. The treatment of choice should be modified for every patient.
authors: Department of Plastic and Reconstructive Surgery, Katip Celebi University Ataturk Research and Training Hospital Izmir Turkey.
authors: Meltem
authors: M
authors: Ayhan
authors: Kamuran Z
authors: KZ
authors: Sevim
authors: Metin
authors: M
authors: Gorgu
keywords: Mentosternal synechia; burn contracture
references: Arch Dermatol. 1988 Feb;124(2):244-9
references: 3277544
references: Plast Reconstr Surg. 2000 Jan;105(1):27-33
references: 10626966
references: Hand. 1980 Feb;12(1):54-61
references: 6988305
references: Br J Dermatol. 1984 Aug;111(2):221-5
references: 6380561
references: Plast Reconstr Surg. 1994 Mar;93(3):507-18
references: 8115505
references: Plast Reconstr Surg. 1999 Apr;103(4):1198-204
references: 10088507
references: Burns. 1996 Feb;22(1):76-9
references: 8719324
references: Hand Clin. 1986 May;2(2):353-9
references: 3517018
references: Ann Surg. 1985 Mar;201(3):374-82
references: 3883921
references: Plast Reconstr Surg. 2000 Oct;106(5):1216
references: 11039398
references: Burns. 2000 Nov;26(7):628-33
references: 10925186
references: Ann Surg. 1989 Apr;209(4):471-4
references: 2930291
references: Prog Pediatr Surg. 1981;14:209-23
references: 7012930
references: J Am Acad Dermatol. 1992 Aug;27(2 Pt 1):151-65
references: 1430351
references: Plast Reconstr Surg. 1991 Feb;87(2):276-84
references: 1989020
references: Br J Plast Surg. 1990 Mar;43(2):145-9
references: 2328374
references: Microsurgery. 1999;19(3):157-65
references: 10231126
references: Burns. 1994 Dec;20(6):547-50
references: 7880424
references: J Trauma. 1999 Dec;47(6):1142-7
references: 10608548
references: Crit Care Med. 1981 Jul;9(7):519-23
references: 7016441
references: Arch Surg. 1985 Sep;120(9):1042-4
references: 3896198
references: Microsurgery. 2000;20(4):186-92
references: 10980519
references: Burns Incl Therm Inj. 1983 Nov;10(2):121-3
references: 6360311
references: Burns. 1999 Feb;25(1):88-92
references: 10090392
references: Surg Forum. 1974;25(0):41-4
references: 4612797
references: Plast Reconstr Surg. 1997 Jun;99(7):1878-84; discussion 1885-6
references: 9180711