A treatment strategy for postburn neck reconstruction: emphasizing the functional and aesthetic importance of the cervicomental angle.

The authors describe an algorithm for reconstruction of both the soft tissue and skeletal components of severe postburn neck deformities. The critical functional and aesthetic importance of the cervicomental angle is emphasized. The neck is subdivided into 3 anatomic subunits: (1) lower lip/chin subunit, (2) submental subunit, and (3) anterior neck subunit. After release of contractures, platysmaplasty is performed to prevent recurrence and to deepen the cervicomental angle. In cases where chin retrusion is present, sliding genioplasty is performed. The 3 subunits are resurfaced individually by skin grafts and free flaps. The combined scapular and parascapular bilobed free flap is an ideal flap for cases involving 2 subunits. Fifty patients with severe postburns neck contractures were treated. After excision and release of scar, 47 (94%) patients underwent platysmaplasty, and 12 (24%) patients underwent sliding genioplasty. Defects were covered with skin grafts alone in 20 (40%) patients, with free flaps only in 22 (44%) patients, and with a combination of skin grafts and free flaps in 8 (16%) patients.