Optimizing Functional and Aesthetic Outcomes in Post-Burn Head and Neck Reconstruction

Background: Optimizing functional and aesthetic outcomes in post burn head and neck reconstruction remains a surgical challenge. Recurrent contractures, impaired range of motion and disfigurement due to disruption of the aesthetic subunits of the face can result in poor patient satisfaction and ultimately contribute to social isolation of the patient. In an effort to improve the quality of life of these patients, this study evaluates different surgical approaches with an emphasis on tissue expansion of free and regional flaps.

Methods: Regional and free flap reconstruction was performed in 20 patients (26 flaps) with severe post burn head and neck contractures. In order to minimize donor site morbidity and obtain large amounts of thin, pliable tissue, pre-expansion was performed in all patients treated with loco-regional flap reconstructions (12/12), and 62 % (8/14) of patients with free flap reconstructions. Algorithms regarding pre- and intra-operative decision-making are discussed, and complications between the techniques as well as long-term (mean follow-up 3 yrs) results analyzed.

Results: Complications, including tissue expander infection with need for removal or exchange, partial or full flap loss, were evaluated and occurred in 25 % (3/12) of patients with loco-regional- and 36 % (5/14) of patients receiving free-flap reconstructions. Secondary revision surgery was necessary in 33 % (4/12) of loco regional flaps and 93 % (13/14) of free flaps.

Conclusions: Both loco-regional-, as well as distant tissue transfers have their role in post-burn head and neck reconstruction, while pre-expansion remains an invaluable tool. Paying attention to the presented principles and keeping the importance of aesthetic facial subunits in mind, range of motion, aesthetics and patient satisfaction were improved long-term in all our patients, while minimizing donor site morbidity.