Pre-expanded Extended Island Parascapular Flap for Reconstruction of Post-burn Neck Contracture

Background. Since it was described by Nassif et al. in 1982, the parascapular flap has been used as a pedicled or island flap for axillary contractures and as a free flap for neck reconstruction. To the best of our knowledge, there are no reports in English describing its use as an island flap for neck reconstruction. Methods. Nine patients with severe post-burn neck contracture scars were reconstructed with pre-expanded extended island parascapular flaps. Results. All flaps survived completely, providing thin skin coverage of the neck defect with satisfactory natural appearance. The size of the flaps ranged from 32 to 44 cm in length and 11 to 16 cm in width (mean: length 38.2; width, 14.2 cm). No debulking was done but secondary revisions such as Z-plasty and scar revision were performed for all flaps. The donor site was closed primarily in all patients but delayed wound healing was recorded in two. Widening and hypertrophic scar changes developed at the donor site of seven patients. Conclusions. The utilization of pre-expanded extended island parascapular flap is an effective way for reconstruction of post-burn neck contracture. It provides a large good-quality skin flap that can cover all the aesthetic units of the neck without any microvascular anastomosis. However, the protracted time required for the procedure and the requirement of two operations, plus the repeated follow-up visits, may constitute major disadvantages.