Cervical Scar Contractures: Experience of the Plastic Surgery Department in Marrakech

Deep cervical burns can lead to disabling sequelae, especially in cases of delayed, incorrect, or inadequate initial burn management. The aim of this study is to report the various epidemiological aspects of cervical contractures, analyze therapeutic modalities, and emphasize the importance of prevention. Our work is a retrospective study spanning a period of 10 years from July 2013 to July 2023, which includes 107 cases of cervical contractures followed at the Plastic and Reconstructive Surgery Department and Burn Unit of the Mohammed VI University Hospital Center in Marrakech. The average age of our patients is 20 years, ranging from 1 to 55 years. 68% of the studied population is female, with a sex ratio of 2.14. They mostly come from a low socioeconomic background. The most frequently found circumstances of the initial burn were domestic accidents, accounting for 80% of all accidents. The etiology of the initial burn is thermal in all patients in our series, 100%. In our study, the majority of cases were initially managed in non-specialized health centers or even at home through traditional practices. Initial treatment involved conventional treatment in 45.5% of cases, early excision with grafting in 22.7% of cases, and physiotherapy (compression therapy, massage) in 22.7% of cases. The topographic distribution of sequelae showed a predominance of anterior neck involvement in 96% of cases. Facial burn sequelae are most frequently associated (70%) with cervical contractures, followed by trunk sequelae (50%). The majority of patients (80.5%) present with deformation of the cervico-mental angle, as well as limitation of cervical extension. Severe cervical contractures (according to Achauers classification) are the most frequent, representing 44.6% of cases. Surgical treatment of these sequelae involves various methods, including skin grafts used in 50.6% of cases, local flaps used in 38.4% of cases, flaps used in 5.5% of cases, and skin expansion used in 5.5% of cases. Functional and aesthetic improvement is achieved in 85.9% of cases, while surgical revision was necessary in 5 patients. Cervical burn sequelae pose a major therapeutic challenge, despite the diversity of surgical procedures, hence the importance of prevention.