Pre-expanded Supraclavicular and Anterior Supraclavicular Perforator Flaps for Serious Neck Burn Scar Contracture Reconstruction Without the Need for Microsurgery.

Abstract

This study investigates the effectiveness of pre-expanded supraclavicular artery perforator (SAP) and combined with anterior SAP (a-SAP) flap for treating second- and third-degree burn-induced neck scar contractures. We conducted a retrospective observational study of 12 patients with severe second- or third-degree burn-induced neck contractures. All patients underwent an expansion technique in 2 stages. The first stage involved the surgical implantation of 2 tissue expanders: one was positioned above the muscular fascia within the deltopectoral fossa, and the other was above the cervico-acromion region's deep fascia. Upon achieving full expansion, a second-stage surgery was conducted. After complete release and resection of cicatricial neck contractures, the composite flap was then tailored to the wound dimensions and transferred after expander removal. Of the 12 cases, each patient received 2 rectangular tissue expanders ranging from 200 to 350 mL. The average inflation period was 21.1 weeks, resulting in an average total volume of 1244.5 mL. Expanded flap dimensions varied from 17 × 19 cm to 33 cm × 21 cm. In 10 patients, flaps exhibited primary healing with complete survival. Complications included venous congestion (2 case), distal end necrosis of the flap (1 case), subflap hematoma (1 case), all managed with conventional wound care or surgical debridement. The donor site was directly sutured and healed primarily in 9 cases, while a partial-thickness skin graft was used for closure in the remaining 3 cases. During a follow-up period ranging from 3 to 26 months, a significant improvement in range of neck motion was observed, along with satisfactory aesthetic outcomes. Integrating pre-expanded SAP and a-SAP flaps provides a promising reconstructive approach for severe cervical contractures. The proximity of the artery to the neck facilitates direct reconstruction without pedicle division, enhancing aesthetic results through improved skin texture and color matching.