Dai Xinyue, Zhang Zixuan, Zang Mengqing, Zhu Shan, Li Shanshan, Chen Zixiang, Jin Shengyang, Liu Yuanbo
Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, China.
J Craniofac Surg. 2025 Sep 1;36(6):2083-2087. doi: 10.1097/SCS.0000000000011094. Epub 2025 Jan 30.
Reconstructing severe cervical scar contractures (SCSC) remains a considerable challenge. This study presents a novel approach to SCSC reconstruction using a combination of pre-expanded bipedicled forehead and lower trapezius musculocutaneous flaps. A retrospective analysis was conducted on 25 patients who underwent this procedure between April 2004 and July 2020. Sixteen patients received a forehead flap combined with a unilateral lower trapezius musculocutaneous flap; in contrast, 9 patients underwent reconstruction using bilateral lower trapezius musculocutaneous flaps. The surgery was performed in 4 stages. First, tissue expanders were inserted into the forehead and back. After sufficient expansion, the lower trapezius musculocutaneous flap(s) were transferred to repair cervicothoracic contractures in the second stage. In the third stage, the pre-expanded bipedicled forehead flaps were elevated to reconstruct lower facial and submental defects. Finally, the forehead flap pedicle was divided after 3 weeks. Patient demographics and surgical outcomes were collected and analyzed. All flaps survived without perfusion-related complications. Postoperatively, improvements were observed in neck range of motion, inferior mandibular border definition, and subhyoid depression. The cervicomental angle reduced considerably from 177.08±1.28 degrees to 106.6±1.18 degrees. In addition, the color and texture of the reconstructed flaps matched the adjacent skin. No scar contracture recurrence was reported during follow-up, which ranged from 4 months to 8 years. The technique, combining pre-expanded bipedicled forehead and lower trapezius musculocutaneous flaps, provides excellent functional and aesthetic outcomes for SCSC reconstruction. It effectively restores the cervicomental angle, inferior mandibular borders, and subhyoid depressions.
重建严重的颈部瘢痕挛缩（SCSC）仍然是一项颇具挑战的任务。本研究提出了一种利用预扩张双蒂额部皮瓣和下斜方肌肌皮瓣联合修复SCSC的新方法。对2004年4月至2020年7月期间接受该手术的25例患者进行了回顾性分析。16例患者接受了额部皮瓣联合单侧下斜方肌肌皮瓣修复；相比之下，9例患者采用双侧下斜方肌肌皮瓣进行修复。手术分4个阶段进行。首先，将组织扩张器植入额部和背部。充分扩张后，在第二阶段转移下斜方肌肌皮瓣以修复颈胸挛缩。在第三阶段，掀起预扩张双蒂额部皮瓣以修复面下部和颏下缺损。最后，3周后切断额部皮瓣蒂部。收集并分析患者的人口统计学数据和手术结果。所有皮瓣均存活，未出现与灌注相关的并发症。术后，患者的颈部活动范围、下颌下缘清晰度和舌骨下凹陷均有改善。颈颏角从177.08±1.28度显著减小至106.6±1.18度。此外，重建皮瓣的颜色和质地与相邻皮肤相匹配。随访时间为4个月至8年，期间未报告瘢痕挛缩复发情况。该技术联合预扩张双蒂额部皮瓣和下斜方肌肌皮瓣，为SCSC重建提供了良好的功能和美学效果。它有效地恢复了颈颏角、下颌下缘和舌骨下凹陷。
