Reconstruction of post-burn anterior neck contractures using a butterfly design free anterolateral thigh perforator flap

Abstract

Anterior neck burns represent a major reconstructive challenge due to severe sequalae including restriction in movement and poor aesthetic outcomes. Common treatment options include skin grafting with/without dermal matrices, and loco-regional and distant free flap transfers with/without prior tissue expansion. Such variation in technique is largely influenced by the extent of burn injury requiring resurfacing. In order to optimize like-for-like reconstruction of the anterior neck, use of wide, thin and long flaps such as the anterolateral thigh (ALT) perforator flap have been reported with promising results. Of note, some patients have a tendency towards severe scar contractures, which may be contributed by the greater extent of inflammation during wound healing. We report our experience at 4 years' followup after secondary reconstruction of severe, anterior neck burn contractures in two patients by harvesting the ALT flap with a butterfly design. This technique provides adequate wound resurfacing of the burned neck and surrounding areas, and provides good neck extensibility by addressing both anterior and lateral aspects of the scar defect simultaneously. Such a flap design reduces tension on wound edges and thus, the risk of contracture recurrence in what remains a particularly challenging type of burn reconstruction.

A Comparison of Handheld Doppler and Indocyanine Green Angiography for Perforator Localization

“…Since their first description by Koshima and Soeda 1 in 1989, perforator flaps have become a mainstay in the reconstruction of defects throughout the body 2–6 . Regardless of the donor site, the preoperative identification of the perforating vessels is imperative for its success.…”

Free Tissue Transfer in the Reconstruction of Neck Contractures after Burn Injury: A Case Series

“…Different free tissue transfers have been described for the correction of cervical burn contractures. These consist mostly of fasciocutaneous flaps such as radial forearm, groin flaps [12], anterolateral thigh flaps [13,14], scapular flaps and thoracodorsal artery perforator flaps [15]. As discussed by Duteille et al, fasciocutaneous flaps from the anterior part of the body, as described in this series, are preferable because of their pliability, and they facilitate better positioning for the two-team approach [16].…”

“…Even if several stages of revision may be needed to remove the excess bulk, the ALT flap remains our flap of choice for neck reconstruction. Attention must be paid to insetting of the flap and secondary defatting procedures to recreate a smooth contour [14,18]. Optimal results are obtained by minimizing the donor site morbidity while scar resurfacing is achieved, which can be challenging in the neck area mainly because of the large size of the area involved and the damage to free-flap donor tissue after major burn injury.…”

Reconstruction of Postburn Mild Anterior Neck Contracture With a Free Thin Anterolateral Thigh Flap

“…Subsequently, Acartürk and Bengur (2020) used a pre-expanded free ALT flap in five patients with postburn severe neck contracture and achieved satisfactory results. Lellouch et al (2020) proposed using a butterfly-shaped free ALT perforator flap for reconstructing postburn severe anterior neck contractures. However, none of these researchers suggested using an ALT flap for mild (i.e., McCauley's Grade I) neck contracture.…”