Use of Tissue Expansion and Serial Z-plasty for Release of Neck Postburn Scar Contracture

Abstract

Z-plasty is widely employed in plastic surgery and its mainly functions include elongation along the axis of the scar, dispersal, and realigning the scar within the lines of minimal tension. It is especially useful to release linear-scar contracture, yet difficult for wide scars. Here, we described a technique of tissue expansion followed by serial Z-plasty for several cases of severe postburn scar contracture. In this procedure, first, full expansion should be achieved in the tissues adjacent to the contracture by tissue expansion. Then, the serial Z-plasty technique with precise trimming and adjustment is performed with adequate tension-free skin to release the contracture. Over a period of 2 years from 2015 to 2017, this technique was employed in moderate or severe postburn scar contracture in four patients (1 male and 3 females) aged 14 to 40 years old. The size of contracture ranged from 5 to 27 cm in diameter. Improved appearance and excellent skin match was observed in our four patients. All patients healed uneventfully without any complications and no patient required revision surgery. The range of motion, short form-36 health survey and Vancouver Scar Scale indicated that this technique offered a durable skin coverage with satisfying appearance in these patients. Through the outcomes of our patients, tissue expansion followed by serial Z-plasty has a great potential to be a useful alternative for the treatment of scar contracture especially for contracture adjacent to cervical joints.