Postburn Reconstruction of the Lower Face and Neck: A Proposed Treatment Algorithm Based on a Retrospective Study.

Abstract

Head and neck burns frequently result in severe functional impairments and significant aesthetic deformities due to extensive soft tissue defects and contractures. Reconstructing these complex defects effectively remains challenging, necessitating strategies that optimize both functional outcomes and aesthetic satisfaction. This study aimed to evaluate the clinical efficacy and safety of pre-expanded internal mammary artery perforator (IMAP) and transverse cervical artery perforator (TCAP) flaps for reconstructing cervicofacial deformities resulting from deep burns. A retrospective review was conducted on 36 patients (14 males, 22 females; mean age 24 years, range 8-45) treated between January 2020 and December 2023 using 42 pre-expanded anterior chest flaps. Patients were classified into 2 anatomically distinct groups based on the location of their cervicofacial deformities. Type I deformities primarily involved the mandibular region (chin and lower cheek), for which pre-expanded IMAP flaps were utilized. Type II deformities involved the cervical region (neck and supraclavicular area), reconstructed using pre-expanded TCAP flaps. This classification guided flap selection to optimize tissue matching and functional restoration. All cases involved a 2-stage approach comprising soft-tissue expansion followed by scar excision and contracture release. Outcomes assessed at 6 months postoperatively included flap survival, functional recovery (neck mobility), aesthetic results, and patient satisfaction. Flap survival was 100%, with no congestion or necrosis reported. Two patients experienced minor infections during the expansion phase, managed successfully with antibiotics. All donor sites were closed primarily without grafting. Postoperative assessments revealed that neck mobility improved significantly, with all patients achieving neck extension exceeding 110° and no residual functional limitations. Aesthetic outcomes were rated as good by 83.3% of patients and acceptable by 16.7%. No donor-site complications or dissatisfaction were reported. Pre-expanded IMAP and TCAP flaps provide reliable vascularity and optimal functional and aesthetic outcomes in cervicofacial reconstruction after deep burn injuries. This structured classification and treatment algorithm allows tailored reconstructive strategies based on defect location and vascular anatomy, promoting enhanced clinical outcomes. Further multicenter studies are warranted to validate these findings and refine standardized protocols.