BACKGROUND: Treatment for neglected or recurred congenital muscular torticollis should be differentiated from primary patients due to the long-standing adjacent tissue contracture. The aim of this study was to evaluate the effect of acellular dermal matrix (ADM) on surgery of recurred and neglected patients of congenital muscular torticollis. METHODS: Forty-nine patients were included in the study. All patients underwent resection at the distal end of the sternocleidomastoid muscle. In the study group of 18 patients (ADM group), the defect caused by myectomy and scar tissue removal was covered with ADM. Passive range of neck motion, head tilt, cosmetic and functional satisfaction, and scar was evaluated and compared with the control group of 31 patients (non-ADM group) during follow-up. Logistic and linear regression analyses with adjustment by propensity score were performed to determine the association between ADM implantation and postoperative variables. RESULTS: The mean follow-up period was 18.8 months. No patient required further operation for recurrence during follow-up. The improvement of neck motion in ADM group was significantly superior to non-ADM group at the 1-year follow-up, and the overall assessment score was significantly higher in the ADM group. Acellular dermal matrix implantation was not associated with increased discharge of total drain. CONCLUSIONS: In patients over 8 years of age with recurred or neglected congenital muscular torticollis, use of dermal substitute to fill the defect caused by torticollis release is effective in achieving satisfactory neck motion. Surgical sectioning of the sternocleidomastoid muscle and ADM graft should be considered in recurred and neglected torticollis.
BACKGROUND: Treatment for neglected or recurred congenital muscular torticollis should be differentiated from primary patients due to the long-standing adjacent tissue contracture. The aim of this study was to evaluate the effect of acellular dermal matrix (ADM) on surgery of recurred and neglected patients of congenital muscular torticollis. METHODS: Forty-nine patients were included in the study. All patients underwent resection at the distal end of the sternocleidomastoid muscle. In the study group of 18 patients (ADM group), the defect caused by myectomy and scar tissue removal was covered with ADM. Passive range of neck motion, head tilt, cosmetic and functional satisfaction, and scar was evaluated and compared with the control group of 31 patients (non-ADM group) during follow-up. Logistic and linear regression analyses with adjustment by propensity score were performed to determine the association between ADM implantation and postoperative variables. RESULTS: The mean follow-up period was 18.8 months. No patient required further operation for recurrence during follow-up. The improvement of neck motion in ADM group was significantly superior to non-ADM group at the 1-year follow-up, and the overall assessment score was significantly higher in the ADM group. Acellular dermal matrix implantation was not associated with increased discharge of total drain. CONCLUSIONS: In patients over 8 years of age with recurred or neglected congenital muscular torticollis, use of dermal substitute to fill the defect caused by torticollis release is effective in achieving satisfactory neck motion. Surgical sectioning of the sternocleidomastoid muscle and ADM graft should be considered in recurred and neglected torticollis.