J Reconstr Microsurg 2006; 22 - A083
DOI: 10.1055/s-2006-947961

Microsurgical Reconstruction of Post Burn Neck Deformities with Free Anterolateral Thigh Flaps

Rodrigo Barreiros 1, Gean Scopel 1, Marcus Ferreira 1
  • 1Divisions of Plastic and Reconstructive Surgery, Hospital Geral de Vila Penteado, São Paulo and Universidade de São Paulo, Brazil

Post burn neck contractures present with functional and aesthetic problems that are a challenge for plastic surgeons. When theses deformities involve small areas, one can utilize z–plasties, local flaps, and skin graft but over extensive areas, free flap transfer must be considered. The free anterolateral thigh flap has been used in severe cases of neck contractures, with good aesthetic and functional results.

Eight patients with extensive anterior neck contractures underwent free flap reconstruction with anterolateral thigh flaps. There were 3 women and 5 men, with a mean age of 24.4 years ( range 10 to 51 ). All cases resulted from flame burns. Included in this series were patients who underwent another procedure previously, consideration of functional deficit ( limited extension and rotation), and aesthetic considerations. After 60 days post surgery, 7 patients underwent a defatting procedure ( liposuction ) of the flap.

In all patients, release of contractures was excellent. All flaps survived well. One case presented with marginal necrosis of 3 x 1 cm of the flap, and another case with a marginal necrosis of the burned area (recipient site). The donor sites were closed primarily in three cases with no dehiscence, and with split–thickness skin graft in five cases, with partial loss in one case. After 3 months, the cervicomental angle (degrees), neck rotation, and extension (cm and degrees) were improved in all patients in relation to the preoperative indexes (p < 0.05). In patients having undergone liposuction procedures, the natural profile and appearance were restored.

The goal of this treatment is to release the contracture and to regain a natural profile and appearance. The free anterolateral thigh flap can cover wide areas and, after a defatting procedure, the patient can present with a good aesthetic appearance. Thus, the use of free flaps is one of the best ways to treat extensive post burn neck deformities.