HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Head and Neck Reconstruction

Fig. 2. ( A–C ) Markings for oral commissure release. Note composite ear grafts for alar reconstruction and eyebrow macrografts.

when a donor site is available. Split-thickness skin grafts are commonly chosen over full-thickness grafts for reconstruction. When inset as 2 separate aesthetic subunits, 1 in the submental plane and 1 in the vertical plane, the cervicomental angle is restored, resulting in good range of neck move- ment and an aesthetically pleasing contour ( Fig. 4 ). 35 When available, local regional flaps from the neck, shoulder, and chest, such as the deltopec- toral flap, may be used for reconstruction with bet- ter color and texture match of anteriorly located neck contractures. 36 Regardless of the flap chose, release of the platysma muscle is essential to achieving a full neck release.

hygiene, and the resulting physical deformity can be psychosocially very stressful for the patient. Neck contracture should be addressed before facial reconstruction because this tension serves as an extrinsic force, which can severely affect facial scar maturation. Neck contracture recon- struction involves skin grafting and use of dermal substitutes, including local flaps, when available, and tissue expansion and distant or free tissue transfer. Contractures caused by limited scarring may often be released with Z-plasties alone. Larger, more diffuse scar contractures, however, once released or excised, result in large defects, making skin grafts a good solution for wound reconstruction

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