Aesthetic Reconstruction of Large Scalp Defects by Sequential Tissue Expansion Without Interval

Abstract

Tissue expansion is indicated in the reconstruction of various scalp defects when there is inadequate adjacent tissue to allow either primary closure of the defect or repair with a local flap. It is the most important armamentarium for aesthetic hair-bearing scalp reconstruction in cases of congenital or required defects. This technique was used sequentially without interval to achieve scalp reconstruction for 12 patients with a defect ranging from 30% to 75% of the scalp (average, 55%). For 12 patients, 32 expansion treatments were undertaken between September 1997 and January 2002. The 12 patients included 3 women, 4 men, and 5 children with a mean age of 20 years (range, 45 days to 36 years). All patients had more than one period of treatment. The most common conditions treated were burns (n=7), trauma (n=1), congenital naevi (n=2), and male pattern baldness (n=2). Reconstruction of 12 large scalp defects has been performed with a 3.1% rate of major complications. Results show that tissue expansion is a safe and efficient but time-consuming technique for aesthetic scalp reconstruction, especially in the case of "sideburn" scenario or large defects. There was no significant alteration in ratio of complications although tissue expansions were made sequentially.

Aesthetic Reconstruction of Congenital Cerebriform Intradermal Nevus by Sequential Tissue Expansion at an Early Age: Ten-year Follow-up

“…[7][8][9] The donor site containing the most similar and aesthetically appropriate tissue for scalp defect reconstruction is the rest of the scalp itself. The use of tissue expanders enables maximum use of the remainder of the scalp in the closure of scalp deformities.…”

“…Aggressive expansion in high-risk anatomic regions such as scar tissue may cause ischemic ulcerations and increase product failure. 9 Whatever its basic pathology, reconstruction of large scalp defects using early re-expansion (sequential expansion) decreases flap contracture and the number of required surgical procedures, resulting in a better cosmetic outcome.…”

Levator anguli oris muscle based flaps for nasal reconstruction following resection of nasal skin tumours

“…The use of tissue expansion is an option to increase the possibility of primary closure but unfortunately this option was not suitable for most of our patients for many reasons: most of the defects were too large for this technique; many patients had a lack of skin pliability and some had recurrent tumors or received radiotherapy; in addition this technique is neither free of complications nor suitable for immediate coverage [6,14]. …”

Scalp reconstruction

“…Journal of Surgical Oncology DOI 10.1002/jso Gurlek et al [12] evaluated the outcome of sequential tissue expansion for defects ranging from 30% to 75% of the scalp in 12 patients. The authors reported a 3.1% rate of major complications and concluded that scalp expansion is a safe and effective technique.…”