Introduction: Postburn neck contracture and hypertrophic scarring cause functional limitation and aesthetic disfigurement. The specific goals in treatment of extensive neck contractures are to release the excessively taut tissues thoroughly, to protect the neck from recontracture, and to regain natural profile, contour, and appearance. Several methods have been used in the treatment of neck contractures with varying success, including skin grafts, local flaps, Z-plasties, and free flaps. The conventional and pre-expanded free groin flap is one of our predominate techniques in this field.

Material and Methods: We present our experience with the conventional (n=5) and pre-expanded (n=6) free groin flap for reconstruction of cervical burn contractures over a period of ten years. Resection of the anterior scar to the limits of the aesthetic units and radical release of neck contracture by transection of contracted platysma muscle was done as a condition for successful reconstruction. If pre-expansion was necessary, skin expansion was performed with elliptic tissue expanders ranging between 700 and 900 cc. Anterior neck defects ranged between 8 × 12 cm and 26 × 17 cm, corresponding approximately to the entire aesthetic unit of the anterior neck. The mean follow-up period was three years; the longest was seven years.

Results: The early postoperative course was uneventful. Ten flaps showed complete healing. In one patient a late thrombosis and flap necrosis occurred. Secondary flap revisions, such as debulking, Z-plasty, and other scar revision procedures were performed in seven cases, three to six months after the initial reconstruction. Physical therapy was initiated as early as one week after the reconstruction. In all patients, long-term follow-up demonstrated normal neck movements in all directions with natural appearance and profile. Donor-site scarring was aesthetically satisfactory.

Discussion: Our experience demonstrates the value of the groin flap for reconstruction of postburn neck contractures. The pre-expansion, if necessary, provides ample tissue for free transfer without compromising direct closure of the donor site. Additionally, it results in increased vascularity, pliability, and elasticity of the groin flap. Nevertheless, it should be remembered that the use of the pre-expanded groin flap is a two-stage procedure and that expander-associated pre-expansion is not without risk. The decision on pre-expansion depends ultimately on the reconstructive demands of the defect. With this concept, we obtained good aesthetic and functional results in the treatment of extensive burn contractures of the anterior neck.