Burns 29 (2003) 842–844 Expanded occipito-cervico-pectoral flap for reconstruction of burned cervical contracture S. Motamed a,∗ , A.J. Kalantar Hormozi a , S. Marzban b a Department of Plastic and Reconstructive Surgery, Shahid Beheshti University, Tehran, Iran b 15 Khordad Hospital, South Aban Karimkhan Street, Tehran, Iran Accepted 12 June 2003 Abstract Postburn neck contracture and hypertrophic scarring can cause functional limitation and aesthetic disfigurement. Reconstruction of severe deformities and scar of neck following healing from burns confronts the surgeon with some of the most challenging problems in reconstructive surgery. Through knowledge of available reconstructive technique accurate diagnosis of tissue deficiency and secondary dis- tortion, imaginative planning and definitive, careful execution of ones surgical plan are the bare minimum items for achieving improvement in a burned deformed neck. The aim of this article is to assess the role of expanded occipito-cervico-pectoral (o-c-p) flap for reconstruction in a series of four patients with severe burn scar of neck and involvement of shoulder back but intact anterior aspect of chest. This is an alternative method of reconstruction burn scar of neck area. © 2003 Published by Elsevier Ltd and ISBI. Keywords: Tissue expansion; o-c-p flap; Cervical contracture 1. Introduction For many years, treatment of extensive burn contractures of the neck has been troublesome to both patients and sur- geons. The psychological and physical stress they constantly suffer from them is very great [1]. When the contracture is limited to a small area, Z-plasties and/or local skin graft of- fer a resolution. Improvements in functional and aesthetic results in head and neck reconstruction continues with the advent of new flaps [2]. With a better understanding of the blood supply to the anterior chest wall [3] the reconstructive ladder of flap options continues to expand. This expansion in flap possi- bilities allows surgeons today to make a more appropriate choice of flap for reconstruction than ever before [4]. There remains a paucity of local flaps for the reconstruc- tion of extensive burns of the neck [5,6]. The Tissue Ex- pander (TE) is a versatile addition to the armamentarium of the burn reconstructive surgeon. This technique allows the surgeon to expand surrounding skin with appropriate color match, texture and minimize donor site deformity. Tissue expansion techniques have proven particularly use- ful in the compliant tissue of the neck [4,7,8,9], offering an ∗ Corresponding author. alternative to skin grafting and distant flaps [10,11] and of- ten yielding superior aesthetic results. This study describes acceptable results using the expanded occipito-cervico-pectoral (o-c-p) flap. The evaluation of four patients treated with o-c-p flap revealed release of the con- tracture, satisfactory appearance, and no recurrence. 2. Materials and methods Between July 1998 and April 2000, four patients were treated with expanded o-c-p flap and followed up retrospec- tively. There were three female and one male, and all suf- fered from severe contracture of neck. These patients underwent two separate operations at an interval of 2–3 months. Prior to operation detection of flap nourishing vessels by Doppler sonography was performed. This flap is based on the occipital area to include descending branches of the occipital artery and the flap is designed to course toward the pectoral region and this type resembles the flap described in the case reported by Yang et al. [11]. After designing the flap, the TE was placed through an incision made in the medial border of the flap adjacent to scar tissue (a pocket larger than the dimension of the ex- pander was created), then two layer closure of incision was done. 0305-4179/$30.00 © 2003 Published by Elsevier Ltd and ISBI. doi:10.1016/j.burns.2003.06.001