Reconstruction of Lower Lip-Neck Contracture Using Skin Graft and Circumflex Scapular Artery-Augmented Occipito-cervico-dorsal Flap.

Severe postburn scar contracture of the neck compromises cervical motion and facial aesthetics. It may also distort the lower lip and dentoalveolar arch. Traditional single‑flap reconstructions often produce flaps that are too thick to adequately restore both regions. A 27-year-old woman presented with a severe contracture extending from the lower lip to the anterior neck, which was reconstructed with a full-thickness skin graft for the perioral region and a circumflex scapular artery and vein-augmented occipito-cervico-dorsal flap for the neck region. Specifically, after complete release of the cicatricial band, the lower lip margin and orbicularis oris were resurfaced with a full-thickness skin graft to restore contour and eliminate lip eversion. Immediately thereafter, the neck was resurfaced with a large, thin occipito-cervico-dorsal flap that was supercharged with the circumflex scapular artery and vein and anastomosed to the facial vessels. Secondary defatting was performed at 7 and 12 months to improve flap pliability and contour. At the 18-month follow-up, the patient had a normal cervicomental angle, adequate neck extension, and a well-matched perioral color. Oral continence was also restored. A region‑oriented strategy-combining a full‑thickness skin graft for the dynamic perioral unit with a large supercharged occipito‑cervico‑dorsal flap for the neck-provides thin, well‑vascularized tissue that can be secondarily contoured. This 2‑stage approach achieved excellent functional and aesthetic outcomes and may serve as a template for similar complex burn‑scar contractures involving both the perioral and cervicomental regions.