title: Region-oriented and staged treatment strategy in reconstruction of severe cervical contracture.
abstract: BACKGROUND
  Severe cervical contracture after burns causes obvious impairment of neck movement and the aesthetic silhouette. Although various surgical techniques for treatment have been described, there is not a definitive strategy to guide treatment. Over the past 6 years, we have been utilizing a region-oriented and staged treatment strategy to guide reconstruction of severe cervical contracture. Satisfactory results have been achieved with this strategy.
  
  
  METHODS
  The first stage of treatment focuses on the anterior cervical region and submental region. Procedures include cicatrix resection, contracture release, division and elevation of the platysma to form two platysma flaps, and skin grafting. Three to six months later, the second stage treatment is performed, which localize to the mental region. This includes scar resection, correction of the lower lip eversion, and reconstruction with free (para)scapular skin flap. Three subtypes of cervicomental angle that we proposed were measured as quantitative tool for evaluation of the reconstruction.
  
  
  RESULTS
  24 patients who completed the treatment were reviewed. By the 3rd postoperative month, their CM angles changed significantly: the soft tissue CM angle was reduced from 135.0° ± 17.3° to 111.1° ± 11.3°, the osseous CM angle increased from 67.1° ± 9.0° to 90.5° ± 11.6° and the dynamic CM angle increased from 21.9° ± 8.7° to 67.4° ± 13.1°. 22 in 24 (91.7%) of these patients gained notable improvement of cervical motion and aesthetic contour.
  
  
  CONCLUSIONS
  Our results suggest that the region-oriented and staged treatment strategy can achieve satisfactory functional and aesthetic results, combining usage of both skin graft and skin flap while minimizing the donor site morbidity.
authors: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University Medical School, Shanghai 200011, China.
authors: Xusong
authors: X
authors: Luo
authors: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University Medical School, Shanghai 200011, China.
authors: Fei
authors: F
authors: Liu
authors: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University Medical School, Shanghai 200011, China.
authors: Xi
authors: X
authors: Wang
authors: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University Medical School, Shanghai 200011, China.
authors: Qun
authors: Q
authors: Yang
authors: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University Medical School, Shanghai 200011, China.
authors: Shoubao
authors: S
authors: Wang
authors: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University Medical School, Shanghai 200011, China.
authors: Xianyu
authors: X
authors: Zhou
authors: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University Medical School, Shanghai 200011, China.
authors: Yunliang
authors: Y
authors: Qian
authors: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University Medical School, Shanghai 200011, China.
authors: Jun
authors: J
authors: Yang
authors: Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors: Lawrence Scott
authors: LS
authors: Levin
mesh_terms: D000328:Adult; D000368:Aged; D002056:Burns / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002921:Cicatrix / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003286:Contracture / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000098:blood supply / Q000293:injuries / Q000601:surgery; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012540:Scapula; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps