Multistage Reconstruction of Complex Postburn Facial Scars: A Multidimensional Reconstructive Approach

BACKGROUND: Severe postburn facial scars may involve multiple anatomical units with different functional and aesthetic requirements. Reconstruction of such deformities may therefore require a staged and individualized approach rather than a single reconstructive procedure. CASE PRESENTATION: A 30-year-old man presented with severe postburn deformities involving the upper lip, lower lip, chin, submental region, and anterior neck. The deformities included severe upper-lip contracture, hyperpigmented scars of the lower lip and chin, and cervical contracture limiting neck extension and rotation. Reconstruction was performed in 2 stages with different flap techniques tailored to each anatomical unit. The upper lip was reconstructed with a hair-bearing superficial temporal artery flap, while the anterior neck was used a supraclavicular fasciocutaneous flap. Six months later, the lower lip, chin, and submental region were rebuilt with a customized, thinned ALT flap with 2 skin paddles. All flaps survived without vascular issues. At 8 years, the patient had good facial contour, color match, natural beard growth over the upper lip, functional lips without distortion, and a soft, stable lower lip and chin. The neck showed no recurrent contracture, with restored cervicomental angle and full extension. Scars remained soft, without hypertrophic recurrence, and the patient was satisfied with both functional and aesthetic results. CONCLUSIONS: Complex postburn facial deformities involving multiple anatomical units can be effectively managed through a multistage, defect-driven reconstructive strategy. Selecting flap techniques based on the specific functional and aesthetic requirements of each defect may provide more appropriate tissue replacement and favorable long-term outcomes.