Tissue Expansion in the Head and Neck: A 6-year Review

Abstract

More than 100 patients (38 in the head and neck) have been treated by the insertion of tissue expanders since the technique was introduced six years ago. Our methods have been refined as we have learned more, and these improvements are described. Morbidity is high when untrained surgeons start to use the technique. The most important decision is the planning of the expander and filling port pockets, but above all the location of the incision(s): Incisions must be kept small and away from the defect, the pocket, and the future flap. Intraoperative filling of the expander reduces the need for drains by preventing haematoma and seroma formation, and reduces the formation of expander envelope folds. The optimal location of the valve is a "quiet" area above or lateral to (or both) the expander, and at least 7 cm away. Mathematical formulas are useless in predicting available flap length, as elasticity and contractility depend on individual factors. A good estimation of flap length is twice the height of the expander above the skin surface or the distance over the dome of the expander minus the corresponding measurement of its base. Overexpansion by 30-50% makes the procedure more predictable.

Tissue expansion 1984–1999: A 15-year review

“…Rupture of the expander was the cause of a major complication in 5/34 (15%), as a result of leakage either from the expander itself, the tube, or from the nipple; other authors have reported 3% to 9% [10,11]. Placing the incision radial or tangential to the expander has been reported to influence the rate of complication during expansion [15,16]. Unfortunately, our patient records did not give us enough information about this.…”

Periosteal expansion of rabbit mandible with an osmotic self-inflatable expander

“…Complications such as intraoral dehiscence were avoided by keeping the incision small and away from the expander, as in other reports [8]. As the expander is quite small it was easy to place it under the periosteum away from the incision line.…”

“…Complications of soft tissue expansion have been described, and the most common are infection, dehiscence, haematoma, and failure [5Á7]. These are best avoided by keeping the incisions small and as distant from the expander and the port as the site permits [2,4,8]. It is to avoid some of these problems with the conventional expander that a self-inflatable expander has been assessed [9,10].…”

“…In the head and neck area the scalp in particular has been successfully reconstructed with expansion of soft tissue [8,12,13]. Noses and ears have also been successfully reconstructed by soft tissue expansion [14].…”

Prevention of Necrosis of Adjacent Expanded Flaps by Surgical Delay

“…3 However, in some cases, little adjacent skin is available to be expanded. In general, the width of the expander must be 2-fold larger than the defect.…”