Reconstruction of postburn neck contractures using free thin thoracodorsal artery perforator flaps with cervicoplasty

Background: Severe postburn neck contractures are devastating functional and cosmetic deformities. The ideal material for coverage of defects created by neck contracture release is thin, supple, large, well-vascularized, healthy tissue. The thoracodorsal artery perforator flap, a workhorse flap for reconstruction, allows a large dimension and free thickness control with low donor-site morbidity. The value of a free thin thoracodorsal artery perforator flap for anterior neck burn deformities has not been evaluated in a substantial series. Methods: Four men and eight women underwent neck reconstruction from December of 2002 to August of 2004. Mean patient age was 34.3 years (range, 21 to 47 years). Thorough burn scar contracture releases were performed and cervicoplasty was added for optimal neck appearance. Uniformly thin thoracodorsal artery perforator flaps were made. Both lateral ends of these flaps were designed with a fishtail shape for sufficient release and to minimize linear scar band formation in the most lateral region of the neck. Results: Elevated flaps as large as 24 X 12 cm and with a mean thickness 5.3 mm were used. All flaps survived without significant complications. Range of neck motion increased, and the cervicomandibular angle was sharpened in all patients. A highly natural neck contour was universally obtained without a secondary debulking procedure. Conclusions: The free thin thoracodorsal artery perforator flap with cervicoplasty provides good functional and aesthetic results in terms of neck contour and cervicomental angle, with a reduced necessity for secondary procedures and low donor-site morbidity. This method is highly valuable for reconstruction of severe postburn neck contractures.