Neck Burn Contracture Surgery in Pune: Restoring Neck Movement

What is a neck burn contracture?

Burns to the front of the neck are common in flame and scald injuries, particularly from kitchen fires and hot liquids. As the burn heals, the scar shortens and thickens. Because the neck bends forward naturally and patients often keep the chin down for comfort while healing, the scar can tighten into a band or sheet that pulls the chin towards the chest.

In mild cases this shows as a tight band when looking up. In severe cases the chin is fixed to the chest wall (a mentosternal contracture), the lower lip is pulled down and out, saliva escapes from the mouth, and turning the head is difficult. Some people also have a stiff, uncomfortable posture and avoid social contact because of the appearance.

Who may benefit, and how is it assessed?

Release is worth considering if the scar limits neck movement, pulls on the lip or jaw, causes drooling, or affects appearance and confidence.

Assessment includes:

1. Measuring movement: how far the head tilts back and turns.
2. Mapping the scar: its width, thickness and whether bands run up into the face or down onto the chest.
3. Checking nearby skin on the chest, shoulders or back that could provide flaps.
4. Airway planning with the anaesthetist.
5. In children, checking jaw growth and the bite.

What are the treatment options?

Option	Suits	Points to consider
Scar care and stretching	Early, mild tightness	Silicone, massage and splints during healing
Z-plasty	Narrow bands with healthy skin on each side	Lengthens the band; limited for wide scars
Release and thick skin graft	Wide sheets of neck scar	Simpler; grafts can contract, so splinting is vital
Local or regional flap (for example from the shoulder or chest)	Moderate to severe contractures	Contracts less; better contour; leaves a donor scar
Tissue expansion before a flap	Large scars with healthy skin nearby	Extra operation and weeks of expansion
Free flap	Severe cases where local skin is burned	Complex microsurgery

Grafting is described under skin grafting surgery, and non-surgical scar care under burn scar treatment. Burns that extend onto the shoulder and armpit are covered under shoulder burn contracture surgery.

How is neck contracture release performed?

1. Airway: the anaesthetist secures breathing safely, sometimes after a partial release.
2. Release: the scar is cut across from side to side at its tightest level, and the neck is extended.
3. Cover: the defect is closed with a thick skin graft or a flap, shaped to recreate the angle between the jaw and the neck.
4. Fixation: the graft is held with a bolster dressing; flaps may have small drains.
5. Positioning: the neck is kept extended, often with a padded splint.

How should you prepare, and what should you ask?

• Keep the scar moisturised and healthy before surgery.
• Tell the anaesthetist about any previous difficulties with anaesthesia.
• Plan for several months of splint wear.

Questions to ask:

• Will you use a graft or a flap, and from where?
• How will my airway be managed during anaesthesia?
• How long must I wear the neck splint each day?
• Will my lower lip need separate correction?

What is recovery like?

Time	What to expect for most patients
Days 1-5	Head kept extended; graft or flap checked; pain relief
Days 5-10	Bolster dressing removed; splint fitted
Weeks 2-6	Stretching exercises and scar care; splint day and night
Months 2-6	Splint mainly at night; pressure or silicone to soften the scar

What are the risks?

• Recurrence of the contracture, especially if the splint is not worn.
• Partial graft or flap loss, needing dressings or regrafting.
• Thick scars at the edges of the graft or flap.
• Colour mismatch between graft and neck skin.
• Donor-site scars on the thigh, chest or shoulder.
• Anaesthetic and airway risks, planned for in advance.

Contact the team for breathing difficulty, increasing neck swelling, fever, or a graft or flap that darkens.

What results can you expect?

Most people gain a clear improvement in neck movement, lip position and appearance after release. Results last when splinting and scar care continue for the months it takes the new tissue to mature.

What happens if a neck burn contracture is left untreated?

A tight neck scar pulls down on the face. The lower lip turns outwards, the mouth may not close, saliva escapes, and in severe cases the lower eyelids are dragged down too. In children, the constant pull can deform the growing lower jaw and upset the bite, which may later need orthodontic or jaw surgery. A neck fixed in a bent position also makes it hard to tilt the head back for a breathing tube, adding airway risk to any later general anaesthetic. For these reasons, a contracture that stops a person looking straight ahead is usually released without waiting for the scar to mature fully. For milder bands, a fitted collar, silicone and stretching can hold the position while scars settle.

Common myths about neck burn contractures

• “Covering the scar with a high collar or dupatta stops it tightening.” Hiding the scar does not stretch it, but a fitted splint and exercises can.
• “A thick pillow helps the neck heal in comfort.” A raised pillow bends the neck forward, so the usual advice is a small roll beneath the shoulders and no pillow under the head.
• “Drooling and a turned-out lower lip are a separate mouth problem.” Releasing the neck often improves lip position and mouth closure.
• “A neck that has been stuck for years is too dangerous to operate on.” Long-standing neck contractures can usually be released, with the anaesthetist planning the airway in advance.

What affects the cost of neck burn contracture surgery in Pune?

• Severity of the contracture and width of the scar.
• Method: Z-plasty, graft, local flap, tissue expansion or free flap.
• Hospital stay and anaesthesia.
• Splints, garments and physiotherapy.