Case 53 Neck Burn Contracture
53.1 Description
Extensive burn contracture involving the neck and anterior trunk
Evidence of previous split- and full-thickness grafts to the neck and torso
Hypertrophic scars and multiple tethering bands
Notable limitation in extension of neck
Obtuse cervico mental angle
53.2 Work-Up
53.2.1 History and Physical Examination (Neck Focused)
Mechanism, depth, and extent of burns
Time interval since injury and treatments performed
History of drooling, difficulty eating, speech deficiencies, abnormal posture, limitation of range of motion of neck, and occlusion
Patient’s aesthetic concerns
Identify contracture bands
Assess for donor site availability
Medical comorbidities
Speech and swallow evaluation
Airway assessment
53.2.2 Pertinent Imaging or Diagnostic Studies
Computed tomography (CT) scan: Obtain cephalometric measurements to assess mandible and chin position; useful to assess recipient vessels (with contrast) if planning for free flap reconstruction
Preoperative anesthesia assessment: Airway needs to be assessed; possible need for direct laryngoscopy, or even neck release under sedation/tracheostomy in extreme cases
53.3 Patient Counseling
Often require multiple surgeries to achieve reasonable range of motion and aesthetics
Surgical outcomes may never meet patient’s hopes in regard to aesthetics
With grafting, postoperative period with long-term splinting; patient needs to be able to demonstrate compliance and understanding of postoperative plan
Recurrent contractures are possible and need to be discussed
Airway may become an emergent issue
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