The classification and treatment algorithm for post-burn cervical contractures reconstructed with free flaps.

Area of Science:

• Plastic Surgery
• Burn Reconstruction
• Reconstructive Microsurgery

Background:

• Neck contractures following burns cause significant functional and aesthetic impairments.
• Effective surgical planning and tissue selection are crucial for optimal outcomes and minimizing donor site morbidity.

Purpose of the Study:

• To introduce a classification system and treatment algorithm for neck contracture release and reconstruction.
• To evaluate the efficacy of free perforator flaps in improving neck motion and aesthetic results.

Main Methods:

• A cohort of 40 burn patients underwent neck release and reconstruction using free perforator flaps between 1999 and 2003.
• Cervical territories were classified (central above, central below, central above and below, lateral) based on movement restrictions and improvement.
• Reconstruction choices were guided by tissue availability, restriction severity, and involved zones.

Main Results:

• Maximal improvement in neck motion was observed at 4 weeks post-surgery and was maintained throughout the 11-month follow-up.
• The type of reconstructive territory significantly impacted the range of motion achieved.
• The central above territory reconstruction demonstrated the most substantial functional gains.

Conclusions:

• A classification system and treatment algorithm effectively enhance neck motion and minimize donor site morbidity in burn contracture reconstruction.
• Free perforator flaps are a valuable tool for restoring function and aesthetics after severe neck burns.
• The central above territory benefits most from free flap reconstruction for improved neck mobility.