Multiple Free Flaps for Cervico Thoracic Burn Sequelae
Claudio Angrigiani, MD1, G E. Artero, MD2, Peter C. Neligan, MD3, Nikhitha P. Thrikutam, B.S.4, Kimberly S. Khouri, B.S.5.
1President Marko Foundation, Buenos Aires, Argentina, 2Santojanni Hospital of Buenos Aires, Buenos Aires, Argentina, 3University of Washington, Seattle, WA, USA, 4University of Texas Southwestern Medical Center, Dallas, TX, USA, 5NYU School of Medicine, Key Biscayne, FL, USA.
PURPOSE:Burn contractures of the neck are treated by scar release and flap-resurfacing. Downward displacement of the flap and loss of the cervico-mental angle is common when the anterior thorax is involved. We present our novel method of preventing this complication by creating two complementary free-flaps in the anterior thorax in addition to aesthetic unit resurfacing.
METHODS: 15 patients with severe burn contractures of the anterior neck and thorax had an extended circumflex scapular flap for neck contracture. Second-stage surgery involved two complimentary flaps placed obliquely to the neck and sown together in the midline. Ages were 16-58 years (avg.32). Two cases utilized SIEA-DIEP, 4 DIEP-DIEP, and 9 ALT flaps. DIEPs measured 20x12cm-18x10cm and ALTs 23x10-18x8cm. Functional results were analyzed according to neck movement. Downward displacement of the flap was measured from its sternal notch inset. Flap descent was evaluated with a tolerance of 2cm.
RESULTS:36-month follow-up revealed complete preservation of the cervico-mental angle in the neck flap and full flexion-extension and lateral rotation of the neck. Results were the same in 5 cases after 5 years. The extended scapular flap used for neck resurfacing remained in place in all the cases with minimal downward displacement.
CONCLUSION:Contrary to standard single flap reconstruction for anterior neck burns, we present two obliquely placed flaps that preserve functional units, aesthetic lines, and prevent the downward pull from scar contracture.
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