Reconstruction of the Severe Cervical Scar Contracture Using a Combination of the Pre-expanded Bipedicled Forehead Flap and Lower Trapezius Musculocutaneous Flap.

Abstract

Reconstructing severe cervical scar contractures (SCSC) remains a considerable challenge. This study presents a novel approach to SCSC reconstruction using a combination of pre-expanded bipedicled forehead and lower trapezius musculocutaneous flaps. A retrospective analysis was conducted on 25 patients who underwent this procedure between April 2004 and July 2020. Sixteen patients received a forehead flap combined with a unilateral lower trapezius musculocutaneous flap; in contrast, 9 patients underwent reconstruction using bilateral lower trapezius musculocutaneous flaps. The surgery was performed in 4 stages. First, tissue expanders were inserted into the forehead and back. After sufficient expansion, the lower trapezius musculocutaneous flap(s) were transferred to repair cervicothoracic contractures in the second stage. In the third stage, the pre-expanded bipedicled forehead flaps were elevated to reconstruct lower facial and submental defects. Finally, the forehead flap pedicle was divided after 3 weeks. Patient demographics and surgical outcomes were collected and analyzed. All flaps survived without perfusion-related complications. Postoperatively, improvements were observed in neck range of motion, inferior mandibular border definition, and subhyoid depression. The cervicomental angle reduced considerably from 177.08±1.28 degrees to 106.6±1.18 degrees. In addition, the color and texture of the reconstructed flaps matched the adjacent skin. No scar contracture recurrence was reported during follow-up, which ranged from 4 months to 8 years. The technique, combining pre-expanded bipedicled forehead and lower trapezius musculocutaneous flaps, provides excellent functional and aesthetic outcomes for SCSC reconstruction. It effectively restores the cervicomental angle, inferior mandibular borders, and subhyoid depressions.