the symptoms attributable to scar include itching , pain , functional disabilities due to contractures and poor aesthetics . these patients suffer from emotional stress , low self - esteem and psychosocial maladjustments and require our attention . platysma muscle flap , in the neck , has been interposed between the scar and underlying structures to correct the depression of scar from surface . the procedure was performed in two patients with depressed scars in the neck . the scar and the adjoining area the skin margins were undermined along with subcutaneous tissues and raised off the platysma muscle . the muscles were superiorly and inferiorly transected from inside the wound margins for transverse mobilisation as advancement flap . the incisions in the muscles were made to the extent that transverse mobilisation could occur for tension - free closure of muscle flaps . the undermined skin margins were mobilised for tension - free horizontal closure . a 40-year - old man presented with a depressed scar in the suprasternal notch . ( a ) preoperative showing depressed scar at suprasternal notch area ; ( b ) defect after excision of scar ; ( c ) platysma muscle flap advanced into the defect ; ( d ) closure of wound transversely ; ( e ) final result a 20-year - old female had depressed scar in the midneck area . she was treated for tubercular lymphadenitis and abscess in childhood at the age of 67 years and the resultant depressed scar was causing concern . the scar was excised and the defect left after excision was volume filled by advancing platysma muscle flap . ( a ) preoperative showing depressed scar at suprasternal notch area ; ( b ) defect after excision of scar ; ( c ) platysma muscle flap advanced into the defect ; ( d ) closure of wound transversely ; ( e ) final result she was treated for tubercular lymphadenitis and abscess in childhood at the age of 67 years and the resultant depressed scar was causing concern . the scar was excised and the defect left after excision was volume filled by advancing platysma muscle flap . the healing of an injured organ occurs by means of a relatively simple mechanism by formation of predominantly fibrous tissue . there may be disturbed or abnormal collagen production during wound healing which is a dynamic and complex process . the stretched scars occur , as in pregnancy , when the dermal elements are damaged without any breach in epidermis . the result is a depressed ( atrophic ) scar when dermal collagen and connective tissue production during the physiological wound healing process inadequately compensates for the tissue loss present after injury . the tracheostomy tug during swallowing , as it is commonly called , is because of loss of underlying tissue which occurs due to pressure necrosis of soft tissues by the indwelling tube . small defects may be filled and improved by edge deepithelialisation technique , dermal fat graft or allogeneic dermal graft . scars in the neck and face , due to various causes , may be improved by filler agents like collagen and hyaluronic acid after releasing deep dermal adhesions . however , depending on the clinical judgment and situation , alloplastic permanent fillers may also be used . reconstruction of anterior neck defect by two platysma myocutaneous flaps has been found to be an option . bilateral platysma flaps by overlapping have satisfactorily been used to correct large , depressed , fixed post - tracheostomy scar . platysma is a muscle sheet which extends from the deep fascia beneath the breast upwards to the inferior border of mandible . the superiorly based flap , with vertical orientation , has vascular axis on submental vessels . the flap can be raised on a horizontal axis , with the vascular supply coming from the posterior neck branches of the transverse cervical and posterior auricular arteries . the use of platysma myocutaneous flap in reconstructing oral defects after carcinoma surgery has low morbidity in the form of a scar at donor site . the plan of scar defect reconstruction by the muscle flap should be reviewed if its harvesting is likely to lead to donor site morbidity . it may occur in the form of residual scarring when the scar defect for reconstruction is not contiguous with the donor harvest site . the defects which are not wide are commonly closed by undermining and mobilisation of the surrounding tissues . the aim of any scar revision surgery is to replace the unpleasant scar with a  good scar  . it is the one which is no more than a fine line , level and even with the surrounding surface ; it is of the same colour as the surrounding skin and causes no contracture , pull or distortion of the surrounding structures . it may be pointed out here that even in suprasternal notch scar , volume replacement was required ( case 1 ) . the amount of tissue needed for replacement purpose in such cases is guided by clinical judgment . scars of this type are rare in the mid - anterior neck , especially in suprasternal notch area and very easily visible . there is a paucity of well - designed , randomised , controlled studies on scar treatment , on which one could rely . the watchword in any scar revision surgery is an imaginative eye that views the result even before revision . the principles of treatment of depressed scar revision are release of inward oriented skin edge , volume replacement and closure of defect in transversely oriented relaxed neck lines . in our cases , after excision of hyperpigmented scar , edges were freed and volume replacement was done by advancing platysma muscle flap . the closure could be done in favourable direction of neck lines . we were able to achieve a good scar . platysma muscle flap is the tissue of choice for providing replacement of lost volume in reconstructing depressed scars in the neck .
background : depressed scars in the neck pose a cosmetic problem . 
 there is a need to fill the lost tissue volume defect between the surface and deeper tissues . 
 it is preferable that the filling is done by autologous tissue which is available in substantial amount in the adjoining area . 
 there should be no donor site morbidity . 
 platysma muscle flap meets these criteria.materials and methods : platysma muscle flap was advanced into the defect after excision of depressed scar . 
 the procedure was done under local anesthetic in two patients.result:the result was a 
 good scar with scar lying in the transversely oriented neck lines.conclusions:platysma muscle flap has a definitive role in revision surgery of depressed scars in neck as it provides an ideal tissue for lost tissue volume .