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Anterior Neck Reconstruction
Clinical Presentation
A 30-year-old White female sustained severe neck contracture from a previous burn injury about 5 years ago. She had excision of the deep burn wound and skin grafting in a local hospital but unfortunately developed severe anterior neck scar contracture ( Fig. 11.1 ). She reported severe limitation of the range of motion (ROM) in her neck especially neck extension and requested a surgical release of the scar contracture so that her neck ROM could be improved ( Fig. 11.2 ).
Operative Plan and Special Considerations
A complete surgical release of the neck scar contracture should be done first. This would create a sizable skin defect that could be reconstructed with several options. Integra wound closure would be the simplest option, but its success may not always be reliable based on this author’s experience. Tissue expansion could be a viable option for some patients but unfortunately this patient had burn and skin graft on her adjacent upper chest. A free anterolateral thigh (ALT) perforator flap can be a good option if the flap could be transferred successfully to the neck after microvascular anastomoses. In this case, neck recipient artery and vein should be dissected first before an ALT flap dissection is started.
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