Release of Face/neck Burn Contracture

SavageGlow · #1 ● 05-06-2024, 09:39 PM

>>A 33-year-old woman admitted to the plastic surgery department, with a severe neck scar contracture developed slowly over a year. 13 months earlier, she was exposed to a burn injury that affected most of her body while she was cooking, that treated conservatively and she later developed scar contractures. The patient was unable to access proper medical care in her area due to the war conditions, which led to this presentation.

>>The contractures cover the neck and extend widely to the chin, mandible, chest and laterally to the upper limbs. Although the burn covered a large area [Fig. 1], the damage did not exceed the superficial layer and did not affect deeper structures such as the trachea, nerves, and thyroid gland. The basic investigations show that the patient had anemia, she was continuously drooling and could not eat because of the shrinkage. There were no previous chronic diseases, no history of drug allergy, and no surgical history.

>>Laboratory tests including Complete Blood Count (CBC) show that the red blood cells (RBC) and hemoglobin (hg) were below the normal range. However, other blood tests, including Prothrombin time (PT), International Normalized Ratio (INR), Glucose test; Urea and Liver Function Tests (LFT) were within the normal limits.

>>In light of our case, the patient underwent contracture release and reconstruction by a specialized team. Before the surgery, the excision site was precisely located and the graft was designed. During the surgery, the patient was placed on the operation table with a neck hyperextension position. Initially, the surgeon made a transverse incision on the scar along the width of the shrunken neck (due to difficulty in intubation). After that, the patient was intubated as shown in Fig. 2. The split-thickness skin grafts were taken from the skin of both thighs. The patient was kept in the hyperextension position, subsequently platysma was carefully excised due to the presence of large vessels, then the Split-thickness skin grafts were placed and fixed [Fig. 2].

>>The Fucidin ointment was applied to the surgical site before the bandage implementation [Fig. 3]. The first bandage was removed after 6 days, after that a supportive cervical collar was put on [Fig. 4]. After a month, the patient was given cervical physiotherapy to improve the neck movement [Fig. 5].

>>The patient stayed for a month in the hospital and was discharged when her general condition became good. A follow-up of the case was not possible, as the patient did not return for routine follow-ups, and we could not contact her.