The webbed neck is one of the conspicuous deformities of Turner syndrome that presents a surgical challenge. Despite the availability of surgical techniques, surgical outcomes are not always acceptable and recurrence occurs. Mehri Turki performed a surgical technique based on a latéral cervical approach allowing direct visual control to manage the fibrotic band. It provides a high level of visual control so that vulnerable anatomic structures are easily protected.
Five girls between 17 and 19 years old, with Turner syndrome, had a webbed neck (pterygium colli) with low and laterally displaced nuchal hairline. The surgical technique aims to correct neck contour and hairline placement while concealing cervical scars. Thus, Preoperative drawing delimitated the harmful triangular hairy skin next to the fibrous band extending from the mastoid to the acromion. Besides, the predefined design drawings provide the exact placement of the future hairline. Choosing a prone position for bilateral and symmetrical repair, the surgical technique was as follows: The incision was made at the junction of the hairless skin and the hairy skin from the mastoid up to the lower end of the webbing skin, in front of the acromion and completed by Z plasty to avoid scar contracture. The subcutaneous skin was undermined in the anterolateral direction, exposing the fibrous fascial band which must be excised to prevent recurrence. the harmful skin having a triangular shape was excised considering the future hairline. Skin closure was done after the superior traction of the posterior cervical advancement.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
5
The incision was made at the junction of the hairless skin and the hairy skin from the mastoid up to the acromion. A subcutaneous undermining allows direct visual control to excise the fibrotic band. Then the hairy skin with a triangular shape was excised. The closure of the defect was done after undermining an anterior cervical flap which was translated in a posterosuperior direction. Z plasty was performed in front of the acromion to prevent scar contracture. Surgical scars are concealed in the hairline which was well placed. The same procedure is done at the same surgical field on the other side to achieve perfect symmetry.
Neck contour
Number of patient obtaining a normal neck contour without lateral fold
Time frame: Just at the postoperative outcome up to 24 months of follow-up
Posterior hairline placement
Number of patients with posterior hairline assent
Time frame: Just at the postoperative outcome up to 24 months of follow-up
Scars placement
Number of patients with a placement of scars at the level of the hairline
Time frame: Just at the postoperative outcome up to 24 months of follow-up
Scars quality
Scars evaluation according to Vancoover scare scale (VSS) for all patients The quality of post-operative scar was evaluated according to VSS as follows: combinations of 4 criteria (1) height (Normal/ 0; 0-2mm/ 1; 2-5mm/ 2 ; \> 5mm / 3) and (2) pliability (Normal 0/ Supple 1/ Yielding 2/ Firm :3 Banding/4, Contracture/5); (3) Pigmentation (Normal : 0/ Hypopigmentation/ 1 Hyperpigmentation/ 2), and (4) Vascularity (Normal/0 Pink/ 1 Red/ 2 Purple/3). scars quality was judged as follows : Excellent result VSS \<1 / Acceptable 1\< VSS \<5 ; Poor scar \>5
Time frame: from 8 months up to 24 months
Recurrece of the fold
Number of patients in whom the fold of the neck recurred
Time frame: 24 months
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