Discussion Of Strategies To The Plastic And Reconstruction Of Neck Scar

Objectives:To summarize and compare the different surgical techniques of neck scar plastic and reconstruction, and to disscuss the main advantages and disadvantages of these treatment strategies.Methods:236cases from march2002to march2013are collected. These cases were diagnosed as different extent of neck scar due to flame, hot fluid, electric injury and other reasons.14of the cases were treated by Z-plasty and the similar ways,144by split-thickness skin graft,72by expanded local flap,3by local flap,3by slipt-thickness expanded skin graf. Statistics are include the age of the patients, the area of the wound after tension-free, the times of operations, the postoperative complications, follow-ups and etc. Different surgical strategies are compared based on the age of patient and size of wound after tension-free treatment through two independent samples nonparametric tests.Results:The area of the wound after tension-free treatment(S) derives from0.1%TBSA to4.5%TBSA. Among which, the propotion of the cases that S≤0.5%TBSA is17.80%, while the propotion of the cases that0.5%TBSA<S≤1%is55.08%, and that of1%TBSA<S≤2%is 23.73%, that of S>2%is3.39%. The14cases treated by Z-plasty and the similar operations all acquired satisfied prognosis. During the144cases of split-thickness skin graft,31cases suffered from partial necrosis of the skin while8of them suffered from infection of the donor site. While during the cases treated by expanded local flap,2cases developed hemodynamic disorder while recovered after hyperbaric treatment,4cases suffered from burst of the expander,5cases suffered from expose of the injection pot or expander,2cases suffered from the infection of the cavity and3cases suffered from bleeding of the cavity.7of the cases underwent reoperations2-10years after the first operations. The3cases of local flap and3cases of slipt-thickness expanded skin graft are all survived. There is signifcant difference of patients age and size of wound after tension-free(S) treatment between the expanded local flap and slipt-thickness strategies (P<0.05). The patient age of the former is elder than the latter while the size of wound after tension-free is smaller (P<0.05)Conclusions:The stategies of plastic and reconstrction of neck scar should be made carefully balanced the skin station of the body, the age of patient, the contraction of the scar, the size of wound after tension-free treatment. Banded and verticle scars which settled inside the normal skin could be treated with Z-plasty and the similar method. Split-thickness skin graft is a choice for younger patients and larger size of wound after tension-free treatment,and this method is better for the patients who need to free the contraction as soon as possible. However, if the patients have proper doner site for local flap, the local flap assistant by expansion is better consider of the minor compliance in donor site and better color and texture that similar to neck. On the patients who suffered from extensive burns, the stategies should be made carefully and all the methods for reconstruction could be used together.