Severe Post-Burn Mentosternal Contracture Release with Meshed STSG

Patient Information

• Age: 21 years
• Gender: Female
• Diagnosis: Mature post-flame burn mentosternal and anterior cervical contracture with severe limitation of neck extension

Procedure

Contracture release with complete excision of pathologic scar, multiplanar Z-plasty adjunct where indicated, and split-thickness skin grafting (STSG) from thigh.

Findings

Eighteen months after 35% TBSA flame burn, the patient had a thick, hyperpigmented, non-pliable scar band from the mentum to the suprasternal notch, restricting neck extension to approximately 10° from neutral. No exposure of great vessels or trachea on clinical exam; fibre-optic assessment of airway not required. Scar had no active ulceration; range of shoulder movement preserved.

Surgical Technique

Contracture line marked in neutral and maximal extension. Transverse and oblique incisions used to achieve 90° release; scar excised until supple, bleeding subcutaneous tissue was reached circumferentially. Defect measured 14 × 9 cm. STSG harvested from left anterolateral thigh with dermatome set to 0.012 inch, meshed 1:1.5, secured with skin staples and bolstered with tie-over Vaseline gauze dressing. Cervical collar applied postoperatively for immobilisation.

Outcome

Graft take approximately 95% at first dressing change (day 5). At 6 weeks, neck extension improved to near-normal with only mild banding at the inferior margin treated with silicone gel sheeting. Patient commenced physiotherapy with progressive extension exercises and pressure therapy. Satisfactory functional and aesthetic improvement at 4-month follow-up.

Clinical Notes

Early post-burn splinting might have reduced severity; this case underscores the value of aggressive release plus grafting when contracture is established. Reserve image slots for pre/post neck extension views.