RESULTS OF FULL-THICKNESS SKIN GRAFTING IN THE MANAGEMENT OF TOTAL POST-BURN CICATRICIAL DEFORMITIES OF THE NECK

ABSTRACT

The medical histories of patients with post-burn cicatricial deformities of the neck treated in the Department of Reconstructive and Plastic Surgery of the Andijan Regional Multidisciplinary Medical Center during 2020–2025 were analyzed.

A total of 22 (100%) patients with subtotal and total cicatricial deformities of the neck underwent surgical treatment. In 11 (50%) patients, no complications were observed in either the early or long-term postoperative periods. In 1 patient (4.5%), pronounced hyperpigmentation was noted, accompanied by areas of depigmentation, resulting in a heterogeneous appearance of the neck skin. Retraction of one-third of the graft was recorded in 1 (4.5%) patient out of 22 (100%).The obtained results indicate that full-thickness skin grafting is an effective method for improving functional and aesthetic outcomes in patients with severe post-burn neck deformities.

АННОТАЦИЯ

Проведён анализ историй болезни пациентов с послеожоговыми рубцовыми деформациями шеи, находившихся на лечении в отделении реконструктивной и пластической хирургии Андижанского областного многопрофильного медицинского центра в 2020–2025 гг.

Всего хирургическое лечение было выполнено у 22 (100%) пациентов с субтотальными и тотальными рубцовыми деформациями шеи. У 11 (50%) пациентов осложнений в раннем и отдалённом послеоперационном периодах не отмечено. У 1 пациента (4,5%) выявлена выраженная гиперпигментация в сочетании с участками депигментации, что обусловило неоднородный внешний вид кожи шеи. Частичное сокращение (ретракция) кожного трансплантата на одну треть зафиксировано у 1 (4,5%) пациента из 22 (100%).

Полученные результаты свидетельствуют о том, что полнослойная кожная пластика является эффективным методом улучшения функциональных и эстетических результатов у пациентов с тяжёлыми послеожоговыми деформациями шеи.

Keywords: scar, burn injury, cicatricial deformity, contracture, neck.

Ключевые слова: рубец, ожоговая травма, рубцовая деформация, контрактура, шея.

Relevance of the Problem. n the treatment of patients with deep burns of the face and neck, three stages of surgical treatment and rehabilitation are distinguished [2,6].

– The first stage is preventive rehabilitation, carried out during the acute period of injury while restoring the lost skin cover. Timely and adequate use of skin grafting is an effective method for preventing cicatricial deformities.

– The second stage is early conservative rehabilitation, which begins after wound closure, when intensive scar tissue formation occurs. Conservative measures are aimed at flattening and softening scars and preventing deformities and contractures.

– The third stage is surgical rehabilitation, which involves plastic correction of cicatricial deformities with restoration of anatomy and function of the affected body region.

In foreign literature, surgical rehabilitation of patients with burns of the face is considered a single continuous process, with three categories of surgical interventions distinguished: urgent procedures threatening vital structures (correction of ectropion, severe microstomia, flexion contracture of the neck), early procedures (functional impairments not threatening vital functions), and late procedures performed after scar maturation with the aim of aesthetic correction [1,4].

In most cases, patients are operated on 1–1.5 years after healing of burn wounds, during the period of scar maturation and regression [3]. Firstly, this provides more favorable surgical conditions, as scars can be easily excised along the intermediate layer. Secondly, surgical intervention does not provoke renewed excessive scar formation, which is observed when fresh scars are damaged [5]. Most researchers unanimously emphasize the necessity of early elimination of forming cicatricial deformities causing functional disorders [2].

In reconstructive surgery of post-burn deformities of the neck and face, all known types of plastic procedures are used: split-thickness and full-thickness skin grafting, Z-plasty, tubed pedicle flaps, rotational flaps from adjacent areas, local tissue plasty using acute and chronic stretching methods, and free composite flaps with microsurgical anastomoses [1,7]. Each method, along with undeniable advantages, has certain disadvantages and does not always provide satisfactory functional and cosmetic outcomes [3].

Materials and Methods. The medical records of 22 patients with post-burn cicatricial deformities of the neck treated in the Department of Reconstructive and Plastic Surgery of the Andijan Regional Multidisciplinary Medical Center during 2022–2025 were studied.

The study is based on the results of surgical treatment of 22 patients aged 7 to 15 years, including 9 (40.9%) boys and 13 (59.1%) girls.

The main damaging factors were flame burns, accounting for 72.7% (16 patients). Patients were admitted at various times ranging from 5 months to 3 years after healing of burn wounds. Full-thickness skin grafts were used to eliminate cicatricial deformities.

Results and Discussion. For harvesting the graft, the most suitable donor sites were considered to be the anterior surface of the upper third of the thigh or the inguinal region. It was noted that during neck plasty using full-thickness skin grafts, traditional alcohol-iodine preparation of the donor site led to partial or complete epidermal detachment due to chemical burns in 25–33% of cases in the postoperative period.

Therefore, during full-thickness skin grafting, alcohol-iodine skin preparation was completely abandoned. Instead, a 25% solution of “Citeal” was used.

Excision of cicatricially altered neck tissues was performed in the presence of coarse, dense scars and keloid masses located on the anterior or lateral surfaces of the neck. Scars were excised together with the altered platysma muscle. After thorough hemostasis, the wound defect was covered with a full-thickness skin graft harvested from the anterior surface of the thigh using a previously proposed technique.

The graft was placed transversely across the wound with overlapping edges and fixed to each other and to the underlying tissues using interrupted U-shaped sutures. The suture ends were tied over gauze pads. On the lateral surfaces of the neck, the wound edges were given a zigzag configuration.

In areas where the graft did not adhere tightly to the wound bed, it was additionally sutured to the underlying tissues using interrupted sutures tied over gauze pads soaked in antiseptic solution. Uniform compression of the graft was ensured using a fixing pressure dressing.

During the first three postoperative days, patients were kept in bed in a horizontal position with the head extended backward to ensure cervical hypercorrection and were fed liquid cold food through a straw. The first dressing change was performed on postoperative days 5–6. Stretching sutures were removed, and existing hematomas were evacuated. Gauze dressings soaked in antiseptic solution were applied to the grafts.

Conditions for graft survival in the neck region are unfavorable due to the difficulty of immobilizing the neck caused by involuntary head movements, respiration, and food intake, as well as traumatized subcutaneous tissue, hemorrhages, ligatures, and uneven wound relief.

Clinical Case. Patient T., born in 1972. Date of injury: 2008. Medical record No. 1690/147. Diagnosis: post-burn cicatricial deformity of the neck and chest. Bilateral midline-lateral neck contracture (Fig. 1).

Operation No. 129 – elimination of cicatricial neck contracture using a full-thickness skin autograft.

Figure. 1. Patient T. A – Post-burn cicatricial deformity of the neck and chest, bilateral midline-lateral neck contracture. B – Long-term result after plastic reconstruction

Results of the Improved Method. Distribution of cicatricial neck deformities by localization (n = 22) treated using improved techniques.

Midline-lateral bilateral neck deformity was observed in 4 (18.2%) patients.

Grade I cicatricial neck contracture was noted in 6 (27.3%) patients, characterized by scar bands, folds, and membranes not limiting head elevation up to 90°.

Grade II contracture was observed in 9 (40.9%) patients, with head elevation limited to 45°.

Grade III contracture was characterized by adhesion of the chin to the sternum, eversion of the lower lip, dental deformities, and severe limitation or absence of cervical spine movements and was observed in 4 (18.2%) patients.

In 3 (13.6%) patients, cicatricial deformities were present without clinical signs of neck contracture.

Results of Neck Plasty Using Full-Thickness Skin Grafts. The full-thickness skin grafting method was applied in all 22 patients.

Excision of cicatricially altered tissues was performed in the presence of coarse dense scars and keloid masses located on the anterior or lateral surfaces of the neck in 9 (40.9%) patients.

All 22 (100%) patients with subtotal and total cicatricial deformities of the neck were operated on. In 11 (50%) patients, no complications were observed in the early or long-term postoperative periods.

Postoperative complications occurred in 2 (9.1%) patients. Complete graft survival was achieved in 10 (45.4%) cases. Marginal graft lysis of 2–3 cm was observed in 2 (9.1%) patients, with spontaneous wound healing.

Pronounced hyperpigmentation with areas of depigmentation was noted in 1 (4.5%) patient, resulting in a mottled appearance of the neck. Retraction of one-third of the graft was recorded in 1 (4.5%) patient out of 22 (100%).

Conclusion. The proposed surgical approach for correcting post-burn cicatricial deformities and contractures of the neck using full-thickness skin grafts contributes to a noticeable improvement in both functional mobility and aesthetic appearance.

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