Successful treatment of large forehead defect after the failure of tissue expansion: changing plan and strategy

Tissue expansion is an effective method in head and neck reconstruction for large defects. Tissue expansion allows enlarged local tissue for advancement or rotation flaps and could result in satisfactory aesthetic and functional outcomes. A 14-year-old boy presented with a 7 × 9-cm(2) traumatic defect on his forehead. We planned a 2-stage operation with tissue expanders. In the first operation, we placed two 100-mL crescent-type tissue expanders supraperiosteally through the scalp hairline incision. After the seventh postoperative day, failure of one of the expanders was found. Hence, we overexpanded the remaining expander using rapid inflation for 7 days (20 mL/d) and changed the plan of the flap design from a bilateral advancement flap to a supratrochlear artery-based unilateral rotational flap. The patient healed uneventfully and had satisfactory results 1 year postoperatively. To overcome tissue expansion failure, an overexpansion technique with multiple small crescent-type expanders was used; a rotational flap based on the supratrochlear artery is a good alternative method.