A Retrospective Analysis on the Proper Size of Tissue Expanders to Treat Scalp Lesions

Abstract

Background:Tissue expanders have become established instruments for scalp reconstruction. However, selection of the size of the expander has not been investigated systematically, and it generally depends on the experience of the surgeon.Methods:We retrospectively analyzed 21 patients who had undergone treatment for scalp lesions using tissue expanders without any complications and measured 2 variables: the volume of the expanders per area of the excised lesions and the hypothetical stretched functional skin width relative to the width of the excised lesions. We also sought to evaluate the relationship between these 2 variables and the need for revision surgery during the postoperative course.Results:The need for revision surgery was statistically higher in patients with a volume of 7 ml/cm2 lesion or less and width of functional skin of less than 2.5 cm/cm lesion (P < 0.05). For scar repairs, the required size and volume of the expanders tended to be larger than those required for any other lesions.Conclusions:Expanders that generate functional skin at least more than 2.5 times the width of the lesion and have a volume more than 7 ml/cm2 lesion are necessary to cover scalp lesions without complications.

Excision of Large Scalp Arteriovenous Malformations with Aesthetic Scalp Reconstruction

“…Once no recurrence is observed, aesthetic hair bearing scalp reconstruction especially for young patients is a must. No other tissue in the human body mimics hair bearing scalp, 5 and providing a near normal hair bearing scalp cover, should be final goal as most of SAVM patients are young individuals with major aesthetic concerns. Multiple methods are available for hair restoration from primary closure, rotation and advancement flaps, hair transplant, scalp reduction, scalp expansion and even free tissue transfer.…”

“… 7 Scalp with its rich blood circulation, thick overlying tissue and rigid skull bone below is an ideal place for expander placement. 5 …”

“…In our study, in 9 out of 10 cases, rectangular expanders were used as they provided the most efficient expansion. 5 The width of the defect was noted and an expander which could generate extra skin 2.5 times the width of defect was taken. The volume of such expander was calculated to about 5-7 mL/cm 2 of the lesion.…”

“…7 Scalp with its rich blood circulation, thick overlying tissue and rigid skull bone below is an ideal place for expander placement. 5 Tissue expansion is governed by concepts of biological and mechanical creep that increases mitotic activity and intrinsic extensibility of the native skin. 2,5 Same principals were used in our study.…”

“…5 Tissue expansion is governed by concepts of biological and mechanical creep that increases mitotic activity and intrinsic extensibility of the native skin. 2,5 Same principals were used in our study. Size, shape and placement of implant provide the optimal results with least complications.…”