BURNS OF THE NECK

Talaat H.A.

Faculty of Medicine, Cairo University, Egypt

SUMMARY. The face, neck and hands are the most frequent parts affected in extensive burn injuries. They are commonly very deeply burned. Local anatornic particulars have a decisive role in the management, the resulting deformity and degree of disability. These anatomic facts aic mainly:

1. the relative thickness of the skin
2. the presence of subcutaneous voluntary muscles: the expression muscles in the face, the platysma in palm
3. the functional anatomic areas, to be respected during planning of skin cover and reconstruction.

The present study includes a total of 1578 cases of fresh bum injuries admitted during a three-year period (Jan. 1985 - Jan. 1988). The neck was affected in 333 cases (2 1%). In the same period 115 cases suffering from burn neck contractures were referred to the Plastic Surgery Unit. The pattern of contracture was classified according to the site, extent and degree. The reconstruction was held long cnough to allow for softening of the scar. The choice of the operative procedure was decided according to the pattern, the available skin suitable for transfer and associated contracture affecting the face, chest wall or axilla. The operative procedures include Z-plasty with or without skin graft, local cervicoplasty, myocutancous flaps, fasciocutaneous flaps and free transfer.

The neck and face are the most frequent areas aflected in extensive burn injuries. The resulting scarring, disfigurement and disability depend on various factors: the severity and depth of the primary injury and the success of the applied treatment scheme.
The neck in particular can be affected by the most severe type of flexion contracture. Some anatomic factors seem to contribute to the pathogenesis of the contracture: the soft thin skin, the presence of a cutaneous muscle, the platysma, and the ability of the cervical vertebral column to flex. These factors act more in younger age groups. The role of the platysma has not been adequately studied. A deep 2nd or 3rd degree burn will force the platysma into a state of reflex spasm. This and the position of rest will bring the neck into flexion. The process of healing, deposition of scar tissue and its gradual maturation by contraction lead to the final position. The scarring will include fibrous replacement of the destroyed platysma fibres. The pattern of neck scarring, its extent and degree can be divided into three main groups:

1. Superficial scarring; localised or extensive
2. Linear scarring; median or lateral
3. Cervical obliteration; partial or total.

Some anatomic factors govern the surgical plan of reconstruction:

1. The skin cover on the neck extending from the lower border of the mandible to the suprasternal border and from the anterior border of the trapezius on either side is 20-25 cm on average (Talaat, 1966).
2. This extensive surface area is not covered by a homogeneous sheet of skin. It includes the submandibular area, the central hyold sternal area, and two lateral areas. The most important of these is the central (h yoid- sterna 1), being most exposed to sight from the front (Talaat, 1966). This 1 s the area to be considered most seriously in the choice of skin cover of the best quality available.

The present study 'Includes a total of 1578 cases of fresh burn injuries admitted during a three-year period (Jan. 1985 - Jan. 1988). The neck was affected in 333 cases (21%) (Table 1).
The pattern of contracture was classified according to the site, extent and degree.
The reconstruction was held long enough to allow for softening of the scar. The choice of the operative procedure was decided according to the pattern, the available skin suitable for transfer and associated contractures affecting the face, chest wall or axilla.
The operative procedures include: Z-plasty with or without skin graft, local cervicoplasty (Talaat, 1966); myocutaneous flaps (Abdel-Gharil et al., 1984); fascio-cutancous flaps (Kadry et al., 1987) and free tissue transfer (Table 2),

RÉSUMÉ. Le visage, le cou et les mains sont les parties du corps plus fréquemment atteintes par les brûlures graves. Ces brûlures sont souvent profondes. Les aspects anatomiques locaux ont un rôle déterminant dans la gestion du traitement, la déformation résultante et le degré d'incapacité. Ces aspects anatomiques sont principalement:

1. l'épaisseur relative de la peau
2. la présence des muscles volontaires sous-cutanés: les muscles de l'expression du visage, le platysma du cou, et les petits muscles de la paume-,
3. les zones anatomiques fonctionelles qu'il faut respecter pendant la préparation de la greffe cutaneé et la reconstruction.

Les Auteurs décrivent 1578 patients avec brûlures fraîches hospitalisés pendant la période triennale janv. 1985 - janv. 1988. Le cou était atteint en 333 cas (21%). Dans la même période 115 patients qui souffraient de contracture du cou à la suite de brûlure ont été reçus dans la Division de Chirurgie Plastique. La catégorie de contracture a été classifiée selon le site, l'étendue et le degré de la brûlure.
La reconstruction a été maintenue jusqu'à permettre l'assouplissement de la cicatrice. Le choix de la procédure opérative dépendait du type de la brûlure, de la peau disponible pour la greffe, et des contractures associées du visage, de la paroi thoracique ou de l'aisselle. Les procédures opératives comprennent: la plastie de décharge à Z avec ou sans greffe cutanée, la cervicoplastie locale, les lambeaux myocutanés, les lambeaux fasciocutanés et le transfert libre.

BIBLIOGRAPHY

1. Talaat H.A.: Burn contractures of the neck. The Journal of the Egyptian Surgical Society. Vol. No. 4, 1966.
2. Abdel-Ghani S., Talaat H.A., Kamal M.S.: Myocutaneous flaps. M.D. Thesis, Fac. of Med., Cairo Univ., 1984.
3. Kadry M., Talaat H.A.: The role of fasciocutaneous flaps in management of neck defects. M.D. Thesis, Fac. of Med., Cairo Univ., 1987.