Evaluation_of_Pre_expanded_Supraclavicular_Flap_in_Reconstruction.pptx

pre expanded suprclav flap

1. Evaluation of Pre-expanded Supraclavicular Flap in Reconstruction of Moderate to Severe Post Burn Contracted Neck and Lower Face Thesis Submitted for Partial Fulfillment of master’s degree in Plastic surgery and Burn By Amr Mohamed Abd- E l Baset Resident of plastic surgery and burn, Al- Ahrar Teaching Hospital

2. Supervised by Dr. Wael Mohamed Ayad, MD Professor of Plastic surgery and burn Faculty of Medicine, Al-Azhar University   Dr. Tarek El Bastawesy Zayed, MD Assistant professor of Plastic surgery and burn Faculty of Medicine, Al-Azhar University   Faculty of Medicine Al-Azhar University- Cairo (2024)

3. تاريخ التسجيل : أكتوبر 2018 موافقة مجلس القسم : يوليو 2022 موافقة مجلس الكلية : يوليو 2022 موافقة مجلس الجامعة : أغسطس 2022

4. INTRODUCTION Neck contractures are associated with esthetic and functional deficit. Severe contractures can result from deep tissue damage involving the lower lip, chin, neck, and chest. Thus, neck scar contracture patients suffer from restriction of neck movement, shoulder stiffness, compensatory kyphosis, incomplete oral occlusion with drooling of saliva, and difficulties with feeding, swallowing, posture, and chin development (Jerome et al., 2021).

5. Many methods have been advocated to reconstruct neck contractures, including Z- plasties , split-thickness skin grafts, full-thickness skin grafts, local or pedicled skin flaps with or without tissue expansion, and free flaps (Ogawa, 2019). The ideal neck reconstruction will preserve the cervicomental angle and possess color and contour match with the surrounding unburnt neck skin (El Sakka et al., 2018). The surgical release and resurfacing may be single staged or multistage (Jerome et al., 2021).

6. The pre expanded supraclavicular artery flap (SAF) is one of the alternative methods for coverage of cervical defects after the release of the burn contractures ( Yang et al., 2014) . This flap provides wide coverage of the post-burn scar contractures defects in the neck and has inherited elasticity postoperatively to achieve good esthetic and functional outcomes (Ismail and Elshobaky , 2016 ). In this study, expansion of the supraclavicular flap was done and evaluation of the aesthetic and functional results of both donor and recipient sites was done.  

7. AIM OF WORK This study aimed to evaluate the Pre-expansion of Supraclavicular Flap in reconstruction of moderate to severe Post Burn Contracted Neck and Lower Face as regards aesthetic and functional result of both donor and recipient sites.

8. Patients and Methods A total of 10 patients with moderate to severe post-burn contracture of the neck and lower face were reconstructed by pre-expanded supraclavicular flap.

9. Inclusion criteria: Proven cases of moderate to severe post burn neck contracture. Sex: Both males & females. Age: all age groups were included.

10. Exclusion criteria: patients unable to complete the follow-up and rehabilitation program. burnt donor site. Patients who had been operated at other places for neck contracture release came with re-contracture at same site. Patients with a history of neck irradiation, trauma or severe scarring in the supraclavicular and neck region, blood clotting issues. Patients who refused to give their consent to being involved in the study.  

11. Surgical Technique First Stage (Tissue expander implantation): Pre operative markings : A handheld Doppler assessment was used to map out the supraclavicular artery and its cutaneous perforator preoperatively. Fig.1 Fig. 1 : Showing the preoperative marking

12. Fig.2 : A . The insertion of rectangular shape tissue expander. B . Expanded supraclavicular artery flap

13. Second-Stage : Contracture release : fig.3, 4

14. Flap elevation and insetting

15. Results

16. Table 1: Demographic properties of studied group   Mean SD Age (Year) 27.2 13.2   N % Sex Male 6 60 Female 4 40

17. T able 2: Frequency of Causes of Burn   N % Flame 5 50 Scald 2 20 Chemical 3 30

18. T able 3: Onah classification Onah N % II 6 60 III 4 40

19. T able 4: Comparison of Pre and post-operative Angle and extension:   Pre-operative Post-operative P value Mean SD Mean SD Extension 90 6 118 11 0.01* Angle 87 5 110 9 0.01*

20. Operative properties SD Mean 10.3 60 1st stage. (Min) 26.6 92 2nd stage (Min 4.3 19.2 Long (Cm) 3.6 12.1 Width (Cm)

21. Early outcome, hospital stay and complications SD Mean 1.6 6.2 Hospital Stay (Day) % N Early 10 1 Hematoma 10 1 Superficial partial distal Necrosis % N Doner site complications 20 2 Hypertrophic edge 10 1 Disruption of wound closed primary

22. Satisfaction N % (excellent) 5 50 (good) 4 40 (fair) 1 10 Table 5: Post-operative satisfaction:

23. Conclusion the Pre-expanded Supra-clavicular flap is a reliable option for the reconstruction of post burn neck contractures. It is safe and offers greater mobility and rotation. It provides a good color match. It may be used safely to reconstruct any size required even in the most severe cervical contractures. the morbidity is minimal as the donor site may frequently be closed primarily without incurring functional impairment.

24. Clinical cases

25. Case 1

26. Case 2

27. Case 1 : pre-operative

28. Thank you