Managing Postburn Neck Contractures in Private Practice

Abstract

Objective: Postburn contractures are well known complication. The cervical region is prone to
scar contractures, traction forces which may pull the chin, cheeks, and lower lip caudally. The
postburn contractures cause major functional and aesthetic problems, so early operative
correction is generally recommended. Many surgical options have been proposed including skin
grafts, local flaps or free flaps. The purpose of this study was to present the experience of
management of postburn contracture by the different surgical options in private setup.
Material & Methods: This study was conducted in a private setup from January 2006 to
December 2007. 11 patients presenting with postburn neck contractures were included. The
surgeries were performed under general anaesthesia with nasal intubation. The selection of the
surgical procedure was done according to individual case. After surgery, the neck was kept
extended using cervical splint (Watusi splint).
Results: The male to female ratio was 1:1.2. The mean age in male patients was 31.2 years and
26.5 years in females. For mild to moderate cases, multiple Z-plasties, skin graft and tissue
expansion were used. For more severe cases, tissue expansion with local flaps and regional flaps
were used. Z-plasties were used in 27.3% cases. Tissue expansion was performed in 36.4%
cases. Supra clavicular flap was used for defect closure in 18.2% of the patients. The range of
motion was found to be satisfactory in most of the cases.
Conclusion: The skin grafts provide a good coverage option after the release of a postburn
neck contracture. It can also be used as bridging operation in staged surgeries. Local flaps
provide good colour and texture match.