[Post-burn cervical retractions: 45 cases and a survey of the literature]

Post-burn cervical contractures are the consequence of deep burns, which are often neglected or badly managed. They affect the patients' general functioning, aesthetic appearance, and psychological state of mind, and treatment can be difficult. We conducted a retrospective study that lasted six years (January 2002-January 2008), analysing epidemiological and clinical features as well as the indications and therapeutic results of 49 patients presenting post-burn cervical contractures treated at the Moroccan National Burns Centre and in our surgery department. Children and young adults were the most affected, with a slight female predominance (59.2%). Domestic burns were the most frequent (93.9%) and thermal burns were the most prevalent aetiology of the accidents (98.0%). Facial burns sequelae were most frequently associated with cervical contractures (67.3% of cases), followed by trunk sequelae (46.9%). Moderate and severe cervical contractures (Achauer classification) were the most frequent, representing respectively 30.6% and 38.8% of the cases. Surgical treatment was based on skin graft (67.3% of cases), local plasties (24.5%), and flaps (8.2%). Among the 47 long-term patients studied, the functional and aesthetic results were considered good in 83.0% of cases and medium in 8.5%; repeat surgery was required in the remaining cases (8.5%). Epidemiologically (patients' age, sex, burn characteristics) and clinically (localization of sequelae, clinical forms), the results of our series are consistent with those in the literature. The importance of initial management (early excision-graft, pressotherapy, and immobilization by neck splint) in reducing the incidence and the severity of cervical burns sequelae is demonstrated. When surgical treatment is indicated, the choice of repair process essentially depends on the extent of the sequelae. Plasties (Z, IC, Y-V…) and local flaps, with or without expansion, are the classic indication in minor contractures. In severe and major contractures, opinion is divided on the choice between skin grafts and flaps. However, whatever surgical treatment is decided upon, rehabilitation is necessary for a final satisfactory result.