Establishment and validation of a nomogram to predict the neck contracture after skin grafting in burn patients: A multicentre cohort study

Abstract

Cervical burn contracture is one of the burn contractures with the highest incidence and severity, and there is no effective method to predict the risk of neck contracture. This study aimed to investigate the effect of combined cervicothoracic skin grafting on the risk of neck contracture in burn patients and to develop a nomogram to predict the risk of neck contracture after skin grafting in burn patients. Data from 212 patients with burns who underwent neck skin grafting were collected from three hospitals, and the patients were randomly divided into training and validation sets. Independent predictors were identified through univariate and multivariate logistic regression analyses and incorporated into a prognostic nomogram. Its performance was assessed using the receiver operating characteristic area under the curve, calibration curve, and decision curve analysis. Burn depth, combined cervicothoracic skin grafting, graft thickness, and neck graft size were significantly associated with neck contractures. In the training cohort, the nomogram had an area under the curve of 0.894. The calibration curve and decision curve analysis indicated good clinical applicability of the nomogram. The results were tested using a validation dataset. Combined cervicothoracic skin grafting is an independent risk factor for neck contracture. Our nomogram demonstrated excellent performance in predicting neck contracture risk.

The Development and Management of Neck Burn Scar Contracture Recurrence

“…10 The aesthetic and functional outcomes associated with postburn neck contracture have led to recent studies examining the epidemiology and predictors of developing a contracture. 9,14 To the best of our knowledge, this is the first study attempting to describe neck CR in burns. In the current study, we examined the surgical management of patients with CR in comparison to those patients who did not suffer CR after their first neck burn scar constracture reconstruction.…”

“…Neck contractures after burn injury have both a high incidence and poor outcomes due to the comparatively thin and mobile skin at the neck, making it more susceptible to deep burn and consequent scar contracture 10 . The aesthetic and functional outcomes associated with postburn neck contracture have led to recent studies examining the epidemiology and predictors of developing a contracture 9,14 . To the best of our knowledge, this is the first study attempting to describe neck CR in burns.…”

“…8 The neck has the highest incidence and poorest burn scar contraction outcomes, due to the region being thin and mobile. 9 The mobility and laxity of the skin covering the neck make it more susceptible to contraction due to less resistance to the tensile forces. 10 In fact, after burn injury, the neck was determined to be the area with the most limited range of motion due to wound contractures.…”

“…The neck has the highest incidence and poorest burn scar contraction outcomes, due to the region being thin and mobile 9 . The mobility and laxity of the skin covering the neck make it more susceptible to contraction due to less resistance to the tensile forces 10 .…”