[Repair of cervical scar contracture with flaps containing cervical cutaneous branch of the transverse cervical artery].

OBJECTIVE

To observe the therapeutic effect of repairing cervical scar contracture using flaps carrying cervical cutaneous branch of the transverse cervical artery.

METHODS

Sixty-six patients with scar contracture after burn in anterior region of neck hospitalized from 1988 to 2011. The scars were excised and repaired with flaps containing the cervical cutaneous branch of transverse cervical artery. They included 55 island flaps (with 9 flaps pre-expanded) and 11 non-island flaps (with 1 flap pre-expanded). After removing the scar and releasing the contracture, flaps with the cervical cutaneous branch of transverse cervical artery were designed and raised in the supraclavicular and infraclavicular regions and the anterior thoracic region. The axial vessel of the flap was the cutaneous artery, which perforated in the crossing area of sternocleidomastoid muscle and omohyoid muscle and originated from the transverse cervical artery. The posterior borderline of the flap reached the anterior border of the trapezius muscle. Its exterior borderline reached the middle part of deltoid muscle, and its interior borderline ended at the midsternal line. The lower borderline was located 3.0-4.0 cm below the nipple. The incisions at the interior, lower, and exterior borders of the flap were first made. Then after sharp dissection to the clavicle, blunt dissection was performed to the pedicle to allow the flaps to be able to cover the wound after rotation without undue tension. The pre-expanded donor sites were sutured directly, while the un-expanded ones were covered with skin graft.

RESULTS

Out of the 66 flaps, 64 flaps survived. Two flaps showed partial necrosis at the distal end due to sub-flap hematoma, and they healed after skin grafting. All the donor sites healed. The color and texture of all flaps matched well with the surrounding skin tissue. The flaps regained sensation pertaining to the chest in the early stage, and complete sensation pertaining to the neck appeared 6 months after surgery.

CONCLUSIONS

The flap containing cervical cutaneous branch of the transverse cervical artery is a good choice for repairing severe cervical scar contracture for its simple harvest, reliable blood supply, and similar color and texture to the skin of cervical region.