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.
