Extended Scalp Expansion for Larger Defects During Staged Cranioplasty

Abstract

Background: Secondary cranioplasty is often required following trauma, infection, radiation, or oncologic care, but is complicated by soft-tissue deficits with limited regional options. Scalp tissue expanders can provide hair-bearing, vascularized tissue for tensionfree closure yielding optimal aesthetic results. However, the upper limit of safe scalp expansion has not been explored. This study sought to evaluate the efficacy of extended scalp tissue expansion for challenging cranioplasties in a consecutive series. Methods: Patients who underwent scalp tissue expansion before cranioplasty were retrospectively identified from a single institution between the years 2017 and 2020. Patient demographics, tissue expansion characteristics, and complications during expansion and after cranioplasty were collected. Results: Six patients were identified who underwent staged scalp expansion for cranioplasty; 5 were male (83.3%) with a mean age of 43.8 AE 12.5 years. Indications for cranioplasty included 2 epilepsyrelated procedures, 1 oligodendroglioma, 2 infectious processes, and 1 traumatic incident. A single expander was used in 5 cases, whereas 2 were used in the remaining case. The average expander fill volume was 434.3 AE 115 ccs with a mean expansion time of 3.3 AE 1.4 months. Expander infection occurred in 1 case and expander exposure in another, but adequate scalp expansion was still achieved in both. Successful closure over cranioplasty was obtained in 5 cases (83.3%); 1 patient ultimately required free flap reconstruction for soft-tissue coverage. Conclusions: In cases of extended scalp defects, scalp tissue expansion remains the preferred method for recruiting large quantities of like tissue before implant cranioplasty.

Application of Skin-stretching Device for Closing Scalp Defect

“…After craniectomy, due to scalp shrinkage and volume contraction, it provided tension in cranioplasty. Previous literatures introduced various methods including flap reconstruction,11 full-thickness skin grafting,12 curvature flattening materials,13 and scalp expansion 14. In our experience, the use of skin-stretching device in cranioplasty could reduce scalp tension and easily suture for the appropriate patient.…”

“…Previous literatures introduced various methods including flap reconstruction, 11 full-thickness skin grafting, 12 curvature flattening materials, 13 and scalp expansion. 14 In our experience, the use of skin-stretching device in cranioplasty could reduce scalp tension and easily suture for the appropriate patient. Moreover, it was more perfect to monitor skin blood perfusion in cranioplasty using skin-stretching device.…”

Large Scalp Defect Reconstruction With Tissue Expansion, Orticochea Flap, and Acellular Dermal Matrix for Soft Tissue Augmentation: A Case Report

“…Tissue expanders allow for primary closure in procedures involving large skin defects. The expansion of the native tissue maintains vascularity and provides adequate skin needed for proper tension-free closure [1,2]. In this case, the gradual expansion of the scalp tissue preceded the wide excision of cancerous lesions.…”

Patch and pulley: A simple and cost-effective approach to surgical management of large scalp defects

“…Tissue expanders, synthetic dermal regeneration templates, and amniotic membrane layers have been described but carry high material costs. 2 Products formulated with growth factors pose a theoretical oncologic risk of promoting tumorigenesis.…”