Acute Intraoperative Sustained Expansion (AISE) With or Without Fat Grafting Versus Local Flaps or Skin Grafts in Managing Facial Disfigurements

Abstract

Introduction: Facial disfigurement or cutaneous defect reconstruction might not be feasible without the aid of either skin grafts or local flaps, but they might have poor color and character match. Although chronic tissue expansion has succeeded to achieve an additional new skin with good match but it is not suitable in many cases. Acute Intraoperative Sustained Expansion (AISE) (rapid expansion) has been introduced as an alternate technique to aid in wound closure following the same strategy of preservation of a good tissue matching but in a single procedure, also when it is combined with fat grafting in case of contour irregularities, it enhance the aesthetic outcome. Patients and Methods:This study included 27 patients with different facial disfigurements or facial cutaneous defects [post tumor excision, post-burn contracture release] located on nose, cheek, temple, or forehead, divided in two groups: Group A (Expansion group) included 13 patients those were treated with (AISE) by using total 21 intraoperative expansion by Foley catheters, five of these patients were managed with additional fat injection when associated with contour irregularities. In the other group, B (Flap/Graft group), 14 patients were managed by local flaps (11 patients) and skin grafts (3 patients). Results: AISE showed success to gain additional skin surface area with each expansion site by dissection, expansion, or both with means of 14.2%, 16.5% and 30.7% of the involved basic relaxing skin surface area respectively with more aesthetic reliability if associated with fat grafting in cases with contour defects. However, expansion sites showed blood collection in 9,6%, closure under tension in 9,6%, partial wound dehiscence in 4.8%. Also, the incidence of patients' dissatisfaction with the results was 23% of cases. Also, the group of local flaps and grafts cases showed poor color and texture matching to the surrounding area 25% in local flap cases and 100% in cases reconstructed by skin grafts, additional facial scars 100% in cases of local flaps, donor site complications and unsatisfactory imaging in 80% of cases, unnatural facial distortion 65%, need for second procedure 28%, wound dehiscence 22%, partial graft loss 33% and flap viability problems 12%.Conclusion: Acute intraoperative sustained expansion could be considered as a reliable reconstructive tool in facial disfigurement, although it doesn't add skin as much as chronic 375 expansion, but it is helpful in assisting closure of wounds without tension, that might otherwise be problematic, it suits small to moderate surface area cutaneous defects, it generates a good matched skin in single procedure, and gives more aesthetic outcome if combined with autologous fat grafting in cases with contour irregularities.