RECONSTRUCTION OF NECK BURNS - A LONG-TERM COMPARATIVE-STUDY BETWEEN SKIN-GRAFTS, SKIN EXPANSION AND FREE FLAPS

Cervical reconstruction after postburn scarring remains a challenge fo r the plastic surgeon. Several well-known procedures are possible: spl it or full-thickness skin grafts, local flaps, free skin flaps, expand ed skin,... In order to evaluate each technique, three procedures are compared with a long-term follow-up (greater than or equal to 1 year): skin expansion, free flap surgery and full-thickness skin grafting. F ifteen patients are reviewed, with five patients operated according to each method. In this study, each burn patient was suffering from a se vere neck burn contracture, restricting the neck motility to a few deg rees. These patients were operated on by different surgeons, according to their personal indications.The full-thickness skin graft is usuall y harvested from the abdomen (by means of a miniabdominoplasty) and is applied under a tie-over dressing. This simple procedure has few comp lications and gives satisfactory results. Skin expansion provides a go od texture and color matching but has a higher morbidity and necessita tes several procedures. Free flap surgery is time-consuming, gives a g ood functional result but poor cosmetic aspect (different colour, exce ssive bulk). Comparing the functional and aesthetic result of the thre e types of reconstruction in terms of morbidity, neck mobility, skin e lasticity, skin sensitivity, matching and scar recurrence, full-thickn ess skin grafting seems to be the most adequate technique.