Luo Xusong, Liu Fei, Wang Xi, Yang Qun, Wang Shoubao, Zhou Xianyu, Qian Yunliang, Yang Jun, Levin Lawrence Scott
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University Medical School, Shanghai 200011, China.
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
PLoS One. 2015 Apr 9;10(4):e0122669. doi: 10.1371/journal.pone.0122669. eCollection 2015.
Severe cervical contracture after burns causes obvious impairment of neck movement and the aesthetic silhouette. Although various surgical techniques for treatment have been described, there is not a definitive strategy to guide treatment. Over the past 6 years, we have been utilizing a region-oriented and staged treatment strategy to guide reconstruction of severe cervical contracture. Satisfactory results have been achieved with this strategy.
The first stage of treatment focuses on the anterior cervical region and submental region. Procedures include cicatrix resection, contracture release, division and elevation of the platysma to form two platysma flaps, and skin grafting. Three to six months later, the second stage treatment is performed, which localize to the mental region. This includes scar resection, correction of the lower lip eversion, and reconstruction with free (para)scapular skin flap. Three subtypes of cervicomental angle that we proposed were measured as quantitative tool for evaluation of the reconstruction.
24 patients who completed the treatment were reviewed. By the 3rd postoperative month, their CM angles changed significantly: the soft tissue CM angle was reduced from 135.0° ± 17.3° to 111.1° ± 11.3°, the osseous CM angle increased from 67.1° ± 9.0° to 90.5° ± 11.6° and the dynamic CM angle increased from 21.9° ± 8.7° to 67.4° ± 13.1°. 22 in 24 (91.7%) of these patients gained notable improvement of cervical motion and aesthetic contour.
Our results suggest that the region-oriented and staged treatment strategy can achieve satisfactory functional and aesthetic results, combining usage of both skin graft and skin flap while minimizing the donor site morbidity.
烧伤后严重颈部挛缩会导致明显的颈部活动受限及美观问题。尽管已有多种手术治疗技术的描述，但尚无明确的治疗策略来指导。在过去6年中，我们一直采用以区域为导向的分期治疗策略来指导严重颈部挛缩的重建，该策略取得了满意的效果。
治疗的第一阶段聚焦于颈前区和颏下区。手术包括瘢痕切除、挛缩松解、颈阔肌的分离与上提以形成两个颈阔肌瓣，以及植皮。三至六个月后进行第二阶段治疗，该阶段定位于颏部。包括瘢痕切除、下唇外翻矫正以及游离（副）肩胛皮瓣重建。我们提出的三种颏颈角亚型作为评估重建效果的量化工具。
对24例完成治疗的患者进行了回顾。术后第3个月，他们的颏颈角有显著变化：软组织颏颈角从135.0°±17.3°降至111.1°±11.3°，骨性颏颈角从67.1°±9.0°增至90.5°±11.6°，动态颏颈角从21.9°±8.7°增至67.4°±13.1°。这些患者中有24例中的22例（91.7%）颈部活动和美观外形得到显著改善。
我们的结果表明，以区域为导向的分期治疗策略能够取得满意的功能和美观效果，联合使用植皮和皮瓣，同时将供区并发症降至最低。
