Grishkevich Viktor M, Grishkevich Max
From the Department of Reconstructive and Plastic Surgery, A.V. Vishnevsky Institute of Surgery of the Russian Academy of Medical Sciences, Moscow, Russia.
J Burn Care Res. 2015 Nov-Dec;36(6):e294-9. doi: 10.1097/BCR.0000000000000205.
Lateral contracture of the neck is a rare and insufficiently researched burn consequent. Contracture restricts head motion, can cause a secondary face deformity, presents severe cosmetic defects, and, therefore, requires surgical reconstruction. Literature does not sufficiently address the issue; therefore, anatomy not researched and treatment techniques not developed. The anatomy of postburn lateral cervical flexion contracture was studied in 21 operated patients. Using obtained data, new approaches were investigated, which were directed toward maximal efficacy of the local tissues use. Follow-up results were observed from 6 months to 9 years. Lateral cervical contractures were divided into two types based on their anatomy: edge and medial. Edge contractures were caused by burns and scars located on the posterior neck surface and were characterized by the presence of the fold in central lateral zone. In the fold, only one (posterior) sheet is scars that cause the contracture. Medial contractures were caused by scars located on the lateral cervical surface and were characterized by the presence of the fold in which both sheets were scars. In both types, contracture was caused by scar sheet surface deficiency in length, which has a trapezoid form (contracture cause). In all cases, there was surface surplus in the fold's sheets allowed contracture release with local tissue. The technique that allows the maximum local tissue use and ensures full contracture elimination is the trapeze-flap plasty. Two anatomic types of lateral cervical scar contractures were identified: edge and medial. An anatomically justified efficacy reconstructive technique for both types is trapeze-flap plasty.
颈部外侧挛缩是一种罕见且研究不足的烧伤后遗症。挛缩会限制头部活动，可导致继发性面部畸形，呈现严重的美容缺陷，因此需要手术重建。文献对该问题的论述不够充分；因此，相关解剖结构未得到研究，治疗技术也未得到发展。对21例接受手术的患者的烧伤后颈部外侧屈曲挛缩的解剖结构进行了研究。利用所获得的数据，研究了旨在最大限度利用局部组织的新方法。随访结果观察了6个月至9年。根据解剖结构，颈部外侧挛缩分为两种类型：边缘型和内侧型。边缘型挛缩由位于后颈部表面的烧伤和瘢痕引起，其特征是在中央外侧区存在褶皱。在褶皱中，只有一层（后部）是导致挛缩的瘢痕。内侧型挛缩由位于颈部外侧表面的瘢痕引起，其特征是褶皱中的两层都是瘢痕。在这两种类型中，挛缩都是由呈梯形的瘢痕片表面长度不足引起的（挛缩原因）。在所有病例中，褶皱片中都有表面多余部分，可通过局部组织进行挛缩松解。能最大限度利用局部组织并确保完全消除挛缩的技术是梯形皮瓣成形术。确定了两种解剖类型的颈部外侧瘢痕挛缩：边缘型和内侧型。针对这两种类型，一种解剖学上合理有效的重建技术是梯形皮瓣成形术。
