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. 2023 Nov 21:11:1269695.
doi: 10.3389/fped.2023.1269695. eCollection 2023.

Repair of cervicothoracic skin defects with extra-long transverse cervical flaps by stepwise pressure packing in children: a technical innovation

Liangliang Kong #  1 , Jiageng Xiong #  1 , Yi Ji  1 , Jie Cui  1 , Jianbing Chen  1 , Weimin Shen  1
Affiliations

Repair of cervicothoracic skin defects with extra-long transverse cervical flaps by stepwise pressure packing in children: a technical innovation

Liangliang Kong et al. Front Pediatr. .

Abstract

Objective: To investigate the clinical effect of prolonging predilated transverse cervical flap with stepwise pressure packing for neck and chest lesions in children.

Methods: A retrospective review of children with large cervicothoracic lesions admitted to our department from January 2011 to June 2021 was conducted to compare stepwise pressure packing with normal dressing in the surgical method of transverse cervical pedicled flaps after expansion. Among 58 included children, 22 (14 males and 8 females) were allocated to the extended and expanded transverse cervical flap with stepwise compression dressing group, and 36 (19 males and 17 females) to the transverse cervical flap group. The causes of skin defects were: scars (37 cases) and giant nevus (21 cases). The course of the disease ranged from 0.5 to 8 years. The two groups were compared in terms of child satisfaction, the occurrence of infection, recurrence of the contracture, secondary operation, and repaired area.

Results: In 22 cases of extended transverse cervical flaps, 8 cases were embedded with two expanders, resulting in a total of 30 expanded flaps, which were successfully transferred to the neck and chest without necrosis at the distal end of compression, with good effect. Comparison of pedicled transverse cervical flaps with stepwise pressure packing and pedicled transverse cervical flaps alone revealed no significant difference in child satisfaction, the occurrence of infection, recurrence of the contracture, and secondary surgery (all P > 0.05). Yet, there was a significant difference in the repair area between two groups (P < 0.05).

Conclusion: Prolongation of pedicled cervical flaps after expansion with stepwise pressure packing resulted in an effective method for repairing the large skin defect of children's face and neck caused by various diseases. In terms of increasing neck repair area, the operation with stepwise pressure dressing was significantly superior to the simple packing.

Keywords: children; neck defect; skin expansion; stepwise pressure packing; transverse cervical flap.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Stepwise pressure packing. (A) Apply pressure by applying a knot to the distal end of the flap. (B) Each knot has slightly less pressure than the previous one to create a pressure gradient. (C) The survival of the distal flap when the compression package was opened the next day.
Figure 2
Figure 2
Applying the pressure pack again on the next day. (A) Applying pressure pack again on the next day. (B) The situation of flap and stitches removal when the package was opened for 7 days.
Figure 3
Figure 3
The area repaired by the transverse cervical flap was compared in the two groups. Results are mean ± SD. ***, p < 0.001. Stepwise, transverse cervical flap by stepwise compression dressing and Normal, transverse cervical flap by normal package.
Figure 4
Figure 4
Photo of example cases. (A) A scar on the left neck and chest. (B) After the completion of the water injection expansion. (C) Surgical design. (D) Stepwise compression dressing method. (E) After the operation.
See this image and copyright information in PMC

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