title: [Serial reconstruction strategy for severe cervical cicatrix deformity].
abstract: OBJECTIVE
  To explore serial reconstruction strategy for severe cervical cicatrix deformity.
  
  
  METHODS
  A total of 24 cases, III or IV degree cervical contracture deformity, were treated in Shanghai Ninth People's Hospital from January 2006 to December 2011. There were 18 males and 6 females with an average age of 35.4 years. The etiologies included burns, chemical injuries and scalding. Three evaluation indices of mental cervical angle (MCA) including soft tissue MCA, osseous MCA and dynamic MCA were measured before treatment and during follow-ups. The first-stage treatment was comprised of cervical cicatrix resection, contracture release, lift of dual direction platysma flap, reconstruction of MCA and skin grafting. At Months 3-6, second-stage treatment was performed, including lower mandible scar resection, correction of lower lip eversion, lower mandible region reconstruction with free (para-) scapular skin flap. After two-stage treatment, the patients underwent periodical re-evaluations for gross appearance, function and measurement of MCA.
  
  
  RESULTS
  Twenty-two patients completing two-stage reconstruction were followed up. Notable improvement of cervical mobilization and contour were achieved. Soft tissue MCA decreased from 130° ± 34° to 110° ± 24°, osseous MCA increased from 71° ± 23° to 95° ± 19° and dynamic MCA increased from 25° ± 18° to 80° ± 26°.
  
  
  CONCLUSIONS
  The serial treatment strategy is effective. In comparisons with reconstruction with skin graft only or skin flap only, the strategy possesses many advantages.
authors.affiliation: Department of Plastic Surgery, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Xu-so
authors.initials: XS
authors.lastname: Luo
authors.forename: Xi
authors.initials: X
authors.lastname: Wang
authors.forename: Qun
authors.initials: Q
authors.lastname: Yang
authors.forename: Fei
authors.initials: F
authors.lastname: Liu
authors.forename: Shou-bao
authors.initials: SB
authors.lastname: Wang
authors.forename: Xian-yu
authors.initials: XY
authors.lastname: Zhou
authors.forename: Yun-liang
authors.initials: YL
authors.lastname: Qian
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D055815:Young Adult