Expanded shoulder flap in burn sequela

The expanded shoulder flap is presented as an alternative for the treatment of cervical retraction secondary to burning. The flap has an axial pattern, mainly based on the transverse cervical artery. The anterior limit of the flap is a line that goes from ear lobule, towards the shoulder, to the deltoid muscle. The incision for inclusion of the tissue expander is made at the shoulder, and on that line, with extension and posterior, lateral and medial detachments broad enough to slightly exceed the expander dimensions, with the valve being placed in infraclavicular position. In the immediate postoperative period, a volume around 15% to 20% of the tissue expander's total capacity was infiltrated, which was followed by weekly infiltrations until the expanded area reached a circumference approximately 2 to 3 times larger than the supposed wound after creating the resection of the retraction. The expanded shoulder flap allows coverage of large extensions, by using a single donor shoulder, as it permits not only release of retraction, but also replacement of associated cervical scars by leaner skin, better adjusted to the region's anatomy. Twelve patients were treated with this method, with good results in all cases, and there being no flap delay. Closing of the donor area happened without any stress, which resulted in scars of good quality.