Systematic Review And Clinical Study Of Reconstructions In Post-Burn Head And Neck Deformities

Head and neck is the most important representative of human being’s appearance and characteristic. Because of the location, it is commonly involved in patients with post-burn sequelae, bringing about discomfort to patient’s life and psychology. Aimed at the reconstruction of post-burn head and neck soft tissue deformities, there were two part of this study. First, we conducted a systematic review to analysis the strengths and weaknesses of each reconstruction technology based on the best available data, and find out the related risk factors for complications. Then, in regard to the supraclavicular flap, which is the most commonly-used flap for reconstruction in post-burn head and neck deformities, we attempted to investigate its anatomical variations and clinical applications by Microbubble-enhanced ultrasound.Part Ⅰ:A Ten-Year Systematic Review and Meta-Analysis of Reconstructions in Post-Burn Head and Neck Deformities[Objective] This systematic review aims to explore literature on reconstructive techniques, complication rates, risk factors for complications, and the quality of existing outcome reporting.[Methods] The Ovid SP versions of Medline, Pre-Medline, and EMBASE were searched using keywords (burn$, reconstruct＄, face$, head$, neck$, complication＄, and outcome$) for articles published from the recent decade. Two reviewers independently extracted data, which were analyzed by meta-analysis and multiple regression. Using the Mantel–Haenszel method, the odds ratio ofsurgical treatments at each recipient site was explored, and the quality of currentoutcome reporting was assessed.[Results] Thirty-five studies were included, yielding1,616patients. The pooledcomplication rate was10.8%, with skin necrosis being the most commoncomplication. According to the results of a2-level analysis, the scalp was a strongpredictor of complications (coef.=80.06, p <0.05). The association betweendifferent surgical treatments and complication occurrences at each recipient sitewas illustrated by odds ratios with95%confidence intervals.[Conclusion] We calculated the most accurate estimate to date of postoperativecomplication rates and other outcomes for post-burn H&N reconstruction, and wescreened potential risk factors for complications. The development of astandardized outcome evaluation system would improve outcome reporting ofpost-burn H&N reconstruction. Part II: Preoperative Mapping of Perforators in Supraclavicular Flaps byMicrobubble-enhanced Ultrasound[Objective] To clarify the anatomical variations of perforators in supraclavicularflaps (SCF) and investigate the effectiveness of microbubble-enhanced ultrasound(MEUS) for detecting perforators preoperatively in supraclavicular flap surgery.[Methods] From May2011to October2012, there were20patients (26flaps wereinvolved) who planned to undergo SCF surgeries to recover the large-area defects in head and neck. The MEUS together with regular color Doppler ultrasound(CDUS) were conducted preoperatively to determine the anatomical features ofperforators branching from supraclavicular arteries (SCA).[Results] MEUS is obviously preferred to CDUS in the results of preoperativelyimaging for perforators. According to the results of MEUS and three-dimensionalreconstructive techniques, we classified these flaps into four types and designedthe flaps. In at least65.4%of the flaps, thoracic branch of SCA (TBSA) is with largecaliber and good flow velocity which can be regarded as the predominant vesseland used as the pedicle of flap. The results of the operations confirmed theexistences of all the marked vessels. No contrast-related complications occurred.All the patients have been followed up for more than three months with well-survived flaps.