Lellouch Alexandre G, Ng Zhi Yang, Pozzo Victor, Suffee Tabrez, Lantieri Laurent A
Department of Plastic Reconstructive Surgery, European Georges Pompidou Hospital (AP-HP), Paris Descartes University, Paris, France.
Division of Plastic and Reconstructive Surgery, and Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Arch Plast Surg. 2020 Mar;47(2):194-197. doi: 10.5999/aps.2019.00591. Epub 2020 Mar 15.
Anterior neck burns represent a major reconstructive challenge due to severe sequalae including restriction in movement and poor aesthetic outcomes. Common treatment options include skin grafting with/without dermal matrices, and loco-regional and distant free flap transfers with/without prior tissue expansion. Such variation in technique is largely influenced by the extent of burn injury requiring resurfacing. In order to optimize like-for-like reconstruction of the anterior neck, use of wide, thin and long flaps such as the anterolateral thigh (ALT) perforator flap have been reported with promising results. Of note, some patients have a tendency towards severe scar contractures, which may be contributed by the greater extent of inflammation during wound healing. We report our experience at 4 years' follow-up after secondary reconstruction of severe, anterior neck burn contractures in two patients by harvesting the ALT flap with a butterfly design. This technique provides adequate wound resurfacing of the burned neck and surrounding areas, and provides good neck extensibility by addressing both anterior and lateral aspects of the scar defect simultaneously. Such a flap design reduces tension on wound edges and thus, the risk of contracture recurrence in what remains a particularly challenging type of burn reconstruction.
由于严重的后遗症，包括活动受限和美学效果不佳，颈部前方烧伤是一项重大的重建挑战。常见的治疗选择包括使用或不使用真皮基质的皮肤移植，以及使用或不使用预先组织扩张的局部和远位游离皮瓣转移。技术上的这种差异很大程度上受需要进行创面覆盖的烧伤损伤程度影响。为了优化颈部前方的同类重建，已报道使用宽、薄且长的皮瓣，如股前外侧（ALT）穿支皮瓣，取得了可喜的成果。值得注意的是，一些患者有严重瘢痕挛缩的倾向，这可能与伤口愈合期间更严重的炎症程度有关。我们报告了两例严重颈部前方烧伤挛缩患者二次重建后4年的随访经验，采用蝶形设计切取ALT皮瓣。该技术可为烧伤的颈部及周围区域提供足够的创面覆盖，并通过同时处理瘢痕缺损的前方和外侧，提供良好的颈部伸展性。这种皮瓣设计可减轻伤口边缘的张力，从而降低在这种特别具有挑战性的烧伤重建类型中挛缩复发的风险。
