The postburn severe flexion contracture neck correction with split-thickness skin graft: Our experience

Introduction: One of the most common burn sequels is postburn contracture (PBC) neck. These contractures affect the patient significantly causing both functional limitations and distorted aesthetic appearance. Therefore, the reconstruction of the head-and-neck area is a challenge for surgeons to restore not only the function but also to improve the esthetic appearance. Materials and Methods: We conducted a tertiary hospital-based prospective study in 12 patients with cases of severe PBC that underwent split-thickness skin graft (SSG) cover as a treatment modality and evaluated the results after the operative procedure in terms of function and appearance of the neck and its complications. Result of the function evaluated with respect to the range of extension movement of the neck –good 120°or more, fair 90°–120°, and bad <90°. Esthetic appearance evaluations were done on the patient's opinion with consideration of color match; maintenance of contour of the neck is good, fair, and not acceptable. Observation and Results: In our study, nine of cases were of thermal burn. All cases were presented with flexion contracture neck, while in seven cases were presented with 0° extensions of the neck. The neck contracture was released in two cases by excision of the scar and in rest of cases by incision methods. The defect was resurfaced with an unmeshed sheet of SSG in six cases, while in six of cases, the defect was resurfaced with a combination of an unmeshed and meshed sheet of SSG. Good functional recovery in terms of extension of the neck >120° in nine cases and fair esthetic appearance in eight cases and good in four cases. Conclusions: The excision of all scar tissue is possible only in few cases, but the incision releases were required in the majority of severe neck contractures. The STS grafting is a simple, reliable, and safe operation. Sheets of unmeshed SSG in the neck and lower face resulted in better postoperative neck function, the cosmetic appearance in terms of color match, and cervicomental angle.