Reconstruction of Post-Burn Neck Contractures: A Systematic Review and Meta-Analysis Comparing Surgical Techniques and Outcomes.

Background: Post-burn neck contractures continue to represent a complex reconstructive problem, with significant functional limitations and a marked impact on patients' appearance and quality of life. This systematic review and meta-analysis aimed to assess surgical outcomes in adult patients undergoing reconstruction for post-burn neck contractures. Methods: A comprehensive search of Medline, Web of Science, and Scopus was performed up to January 2025. Studies reporting surgical management of post-burn neck contractures were included. Primary outcomes were functional and aesthetic improvement, while secondary outcomes included complications, recontracture, and disfiguring scarring. Results: In total, 46 studies comprising 1636 patients were included. Flap-based reconstruction was the most frequently applied approach. Overall, functional improvement was achieved in 92% of cases (95% CI: 89-94%), while satisfactory aesthetic outcomes were reported in 90% (95% CI: 85-93%). The pooled complication rate was 15% (95% CI: 11-20%), with higher rates observed following free flap reconstruction. The incidence of recontracture and disfiguring scarring remained relatively low, about 6%. Although functional outcomes were comparable across flap types, regional flaps appeared to offer the most favorable balance between aesthetic results and complication rates. In contrast, skin grafts and dermal substitutes showed less consistent outcomes and a higher tendency toward recurrence. Conclusions: Flap-based reconstruction remains the cornerstone of treatment for post-burn neck contractures. Surgical planning should be individualized, taking into account defect severity, tissue availability, and surgical expertise. Further prospective studies using standardized outcome measures are needed to strengthen current evidence.