Modified "Posterior Cervical Lift" Correction of Webbed Neck Deformity

Pterygium colli (webbed neck) is a rare congenital deformity that continues to pose reconstructive challenges for the plastic surgeon. The primary goal of surgical management is to create a harmonious cervical profile while restoring the natural hairline. Various techniques have been proposed to correct this deformity; however, the majority of them are associated with recurrence of the web or hypertrophic scarring. A technique similar to the "posterior cervical lift" by Chatput et al has been adopted at the authors' institution for the management of pterygium colli. In its original description, the redundant skin is excised from the posterior neck followed by retention and advancement of the superficial cervical fascia with fixation to the nuchal ligament. To further improve outcomes of this approach, the authors propose 2 modifications to the technique. These include (1) transfixion of the deep fascia with anchoring sutures between the 2 cervical flaps and (2) a customized excision of the redundant tissue at the distal aspect of the wound with local tissue rearrangement. This case report outlines the successful utilization of this modified posterior cervical lift in a 4-year-old patient with Noonan syndrome. At 6 months postoperatively, the patient had significant improvement in neck contour, normalization of the posterior hairline, and no hypertrophic scarring. This modified technique may prove to be an effective approach for the surgical correction of webbed neck deformity.