title: Strategies for customized neck reconstruction based on the pre-expanded superficial cervical artery flap.
abstract: BACKGROUND
  It is still highly challenging to restore the esthetic neck contour for postburn deformities. In many patients with burns, the back skin remains intact, which is a useful donor site for extensive contracture release. As the main technique, the refinement of the pre-expanded superficial cervical artery (SCA) flaps may improve its application in diverse neck contractures.
  
  
  METHODS
  This study reviewed the cases of three types of neck contractures that were reconstructed with pre-expanded SCA flaps: (1) for unilateral neck contractures, the flaps were harvested as pedicled perforator flaps including a small amount of muscle; (2) for lateral and anterior neck contractures, vascular augmentation with circumflex scapular vessels was used to increase the flap size; (3) for contractures of the entire neck, maximal flap release with pedicle dissection toward the origin of the superficial cervical vessels allowed for reaching contralateral defects.
  
  
  RESULTS
  From March 2010 to September 2012, pre-expanded SCA flaps were recommended in 15 patients with severe neck contracture. Tip necrosis occurred in one patient. The donor sites were closed primarily in all cases. One patient had donor-site wound dehiscence that healed within 2 weeks by conservative management. All patients had restored neck extension to a near-normal position without the sense of restricted neck flexion or rotation.
  
  
  CONCLUSIONS
  Pre-expanded SCA flaps are practical and flexible for the reconstruction of diverse scar contractures ranging from unilateral to total neck lesions. Considering the reconstructive efficiency and the reduced donor-site morbidity, this flap may be an ideal option for the reconstruction of severe neck scar contractures.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Haizhou
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Yiwen
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Zijing
authors.initials: Z
authors.lastname: Du
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Gu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Hand, Plastic, and Aesthetic Surgery, Department of General, Trauma, Hand, and Plastic Surgery, University of Munich, Munich, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Herrler
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China. Electronic address: dr.liqingfeng@yahoo.com.
authors.forename: Qingfeng
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China. Electronic address: zantaodoctor@gmail.com.
authors.forename: Tao
authors.initials: T
authors.lastname: Zan
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000601:surgery*; D002921:Cicatrix / Q000209:etiology / Q000601:surgery; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009333:Neck / Q000098:blood supply / Q000601:surgery*; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D015626:Tissue Expansion; D055815:Young Adult
keywords: Neck reconstruction; Perforator flaps; Superficial cervical artery flaps; Tissue expansion