Closure of Scalp and Forehead Defects Using External Tissue Expander

Abstract

External tissue expansion is a safe and effective technique for closing large scalp and forehead defects that would otherwise require skin grafting or free flap reconstruction.

Multidisciplinary Application of an External Tissue Expander Device to Improve Patient Outcomes: A Critical Review

“…As detailed in the Head and Neck, Including Scalp section, a prospective case series included seven cases using DermaClose for scalp wounds. 35 Primary closure was achieved in five of seven patients. One patient with poorly controlled diabetes, who previously underwent external beam radiation, experienced partial skin loss and required bilateral advancement rotational flaps.…”

“…35 Tissue expansion allows replacement with like-for-like tissue, potentially improving cosmetic appearance compared with other techniques. 35 Clinical evidence. A retrospective, singlecenter study of six patients underwent definitive cranioplasty with preoperative CETE reported an average 16% increase in scalp surface area (range, 6.6-35.0%), resulting in all patients having adequate tissue for tension-free closure.…”

50 Tissue Expansion in Facial Reconstruction

“…These devices come in the form of adhesive and elastic tapes 44,45 or a mechanical tensioning device. 46 Both of these devices are applied for 1-14 days depending on the defect or surgical goal. As such, the principle benefit is derived from mechanical creep as described previously as there is not enough time for the physiological changes seen in prolonged expansion to occur.…”

“…The external adhesive devices (DynaClose; Canica Design Inc.) have proven useful in the primary closure of forearm free flap donor sites when applied to the donor site 1 week prior to flap harvest. 44,45 The external tensioning device (Derma Close RC; Wound Care Technologies Inc.) has proven useful in the management of large scalp defects with reduction in wound size from 50 to 99% after 6 to 14 days of external expansion 46 (Fig. 50.3).…”

Scalp Reconstruction

“…Some case series with promising results have been reported in the literature. 61,62 However, further clinical experience is warranted before widespread use of these novel devices.…”