Experience with novel uses of tissue expanders in burn reconstruction of the face and neck

Total or subtotal resurfacing of the face with suitable, well-matched skin from the upper trunk and neck is usually difficult because of the dearth of unscarred donor site. Tissue expanders have been used primarily to construct local advancement flaps of tissue immediately adjacent to a tissue defect or deformity. These flaps often lack adequate mobility to allow coverage of large areas. In this report, I describe a clinical experience of 11 patients followed for 27 to 75 months in whom tissue expanders were used to develop large, full-thickness skin grafts or transposition flaps for total or subtotal resurfacing of the face and neck. Large, full-thickness skin grafts were developed from relatively small donor sites using tissue expanders. They behaved identically to unexpanded full-thickness skin grafts. They were found not to shrink with storage. The donor sites were closed primarily, obviating the need to graft the donor site. The tissue expander-enhanced transposition flaps appeared to have enhanced vascularity and provided ample, suitable tissue for reconstruction of the face and neck. Tissue expansion resulted in very mobile, thin, hearty flaps that provided excellently matched skin cover for the face and neck. Complications, some of which are unique to these techniques, and indications for the techniques are reviewed.