NECK SCAR CONTRACTURE MANAGEMENT IN BURN RELATED INJURIES
Tiffany E. Jeong*, Mario Alessandri Bonetti, Hilary Liu, Guy Stofman, Francesco Egro
Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
Post-burn neck scar contractures can cause severe functional limitations and aesthetic deformity, leading to psychological distress and social interaction impairment. However, there is a lack of literature exploring differences in long-term outcomes based on surgical management strategies. In this study, we report the clinical course and outcomes of post-burn neck contractures management through a single center's experience over 12 years.
We conducted a retrospective study to review outcomes of neck contractures in burn patients undergoing plastic surgery between April 2009 and December 2022 at the Department of Plastic Surgery - Mercy Hospital UPMC.
A total of 25 patients were operated on for post-burn neck contractures. Overall, 43 surgical scar release procedures were performed, with a mean follow up of 34.4±23.7 months. The average TBSA (%) was 33.6±20.4. The most common treatment was excision + skin grafting (n=9 STSG, n=2 FTSG), followed by Z-plasty (n=10, 23%). In 2 patients, a total of 5 tissue expanders were placed. Pectoralis major flap was performed in 2 cases. 2 other patients received pedicled latissimus dorsi flap and ALT free flap.
Scar contracture recurrence was the most frequent complication (N=7, 28%). In 6 cases, the acute burn treatment was skin grafting (3 dermal substitute + STSG, 1 STSG and 2 FTSG), and Z-plasty in 1 case. Other complications were infection (n=3, 7%), hematoma (n=1, 2%), partial graft loss (n=1, 2%), flap loss (n=1, 2%).
Skin grafting was more associated with contracture recurrence. As flap construction becomes more common in neck burn contracture management, there will be a need to compare post-burn neck contracture surgical management strategies.
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