Microsurgical Combined Scapular/Parascapular Flap for Reconstruction of Severe Neck Contracture: Case Report and Literature Review

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Abstract
The reconstruction for severe neck contracture is difficult, because it may include not only the necessity the use of a large flap but also the ability for three-dimensional movement of the neck. A 41-year-old woman sustained a severe neck contracture with retraction of the lower lip and limited range of neck motion after a chemical burn. We used the combined scapular/parascapular flap to reconstruct the soft-tissue defect in the neck after excision of hypertrophic scar and release of contracture. The scapular portion was transferred to cover the defect vertically, and the parascapular portion was transferred to cover the transverse portion of the neck. This kind of design would allow the patient to move her neck more easily. Postoperatively, the range of motion of the neck was full in the vertical and horizontal directions after 6 months of rehabilitation. Also, the patient was satisfied with the final aesthetic results. The microsurgical combined scapular/parascapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during surgery, is a good option for reconstruction of the severe neck contracture. We classify the inset of the combined scapular/parascapular flap into three types with six subtypes, according to the location of defects and the relation of the parascapular flap to the scapular flap.