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Volume 39 Issue 9
Sep.  2023
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(9): 813-819
Wang ZG,Pei JM,Liu CH,et al.Clinical effects of free transplanted pre-expanded scapular flap in reconstructing scar contracture deformity of neck[J].Chin J Burns Wounds,2023,39(9):813-819.DOI: 10.3760/cma.j.cn501225-20230225-00059.
Citation: Wang ZG,Pei JM,Liu CH,et al.Clinical effects of free transplanted pre-expanded scapular flap in reconstructing scar contracture deformity of neck[J].Chin J Burns Wounds,2023,39(9):813-819.DOI: 10.3760/cma.j.cn501225-20230225-00059.
shu

Clinical effects of free transplanted pre-expanded scapular flap in reconstructing scar contracture deformity of neck

doi: 10.3760/cma.j.cn501225-20230225-00059
  • 1.

    Department of Skin Burn and Plastic Surgery, Xijing 986 Department, Fourth Military Medical University, Xi'an 710054, China

  • 2.

    Department of Plastic Surgery, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

General Program of National Natural Science Foundation of China 82072182

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  • Corresponding author: Pei Jiamiao, Email: 601292011@qq.com
  • Received Date: 2023-02-25
    Abstract
  •   Objective   To investigate the clinical effects of free transplanted pre-expanded scapular flap in reconstructing scar contracture deformity of neck.   Methods   A retrospective observational study was conducted. From February 2010 to August 2020, 17 cervical scar deformity patients (9 males and 8 females, aged 8-42 years) who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. The patients underwent skin and soft tissue expander (hereinafter referred to as expander) implantation in scapular region in stage Ⅰ procedures, and the free transplanted pre-expanded flaps were used to resurface the wounds followed by neck scar resection in the stage Ⅱ procedures. The wound size after neck scar release was 12.0 cm×6.0 cm-30.0 cm×24.0 cm, and the size of the flap ranged from 13.0 cm×7.5 cm to 31.5 cm×25.0 cm. The wounds in donor site of 15 patients were sutured directly, and the wounds in donor site of 2 patients were covered with full-thickness skin graft from abdominal area. The survival of flaps was observed after the operation of stage Ⅱ. Six months after stage Ⅱ surgery, Z plasty was performed to treat the incision scar contracture in 2 patients. For the 5 patients of overweight or bloating appearance in the 1/3 proximal flap underwent debulking procedures in 6-9 months after stage Ⅱsurgery. Before the stage Ⅰ surgery and six months after the last procedure (stage Ⅱ or stage Ⅲ), mental cervical angle (MCA) and cervical mandibular angle (CMA) were measured and the improvement of neck scar was evaluated by the angle values. The cervical motor function, skin color and texture in recipient areas, and scar in the donor sites assessed by Vancouver scar scale (VSS) were observed during follow-up. Data were statistically analyzed with paired sample t test.   Results   After stage Ⅱ surgery, 15 patients' flaps survived well; venous crisis occurred in 2 flaps within 24 h after operation, and the flaps survived well after emergency exploration and thrombus removal+vascular re-anastomosis. Compared with the angle values of MCA of (126±12)° and CMA of (148±13)° of patients before the stage Ⅰ surgery, the angle values of MCA of (107±12)° and CMA of (123±11)° of patients in six months after the last procedure were significantly decreased (with t values of 10.68 and 6.54, respectively, P<0.05). After 2 years of follow-up, the patient's neck dorsiflexion, lateral bending, or other motor functions were not restricted; the color and texture of the flap in recipient site were close to those of the normal neck skin; the patient cases with VSS scores of scarring of 3, 4, 5, 6, and 7 were 1, 3, 7, 5, and 1 case, respectively.   Conclusions   The free transplantation of the pre-expanded scapular flaps can provide sufficient tissue for wound coverage after the release of cervical scar contracture deformity; the expanded skin tissue is featured by thin soft tissue and good pliability, which is conducive to restore the neck appearance; the donor sites are relatively covert with less tension, therefore, the treatment is an effective method for correcting the contracture in the neck.

     

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