Release of burn scar contractures of the neck in paediatric patients

Burn scar contractures of the neck represent a continuing problem for plastic surgeons. A review of 143 neck-release procedures performed at the Cincinnati Shriners Burns Institute documented a high rate of contracture recurrence. This was especially true in those patients who had previously suffered burns to the entire anterior neck. Treatment of this condition with Z-plasties, or releasing incisions with split thickness skin grafts, had a recurrence rate of 81 per cent and 62 per cent, respectively. The use of a neck hyper-extension brace for over 1 year following skin grafting decreased the recurrence rate to 17 per cent. In patients who were not compliant in wearing a brace, the best result was obtained by using a full thickness skin graft in the release site. Contractures resulting from smaller burns were successfully handled by a variety of techniques.