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Long-term results in scalp tissue expansion in children
Marie Maillet-Declerck1, Clotilde Calibre, Bernard Herbaux
1Clinique de Chirurgie et d'Orthopédie de l'Enfant, Hôpital Jeanne de Flandre, Lille, France. m_maillet76@hotmail.com
Insights
Scalp tissue expansion in young children is effective for large lesions. Cranial deformities are temporary, and scar widening can be minimized with proper surgical techniques, ensuring good cosmetic outcomes.
Area of Science:
- Pediatric Surgery
- Plastic Surgery
- Craniofacial Surgery
Background:
- Tissue expansion is a common method for scalp reconstruction in pediatric patients.
- While short-term complications are documented, long-term effects like skull deformation and scar widening require further analysis, especially in very young children.
Purpose of the Study:
- To evaluate the long-term outcomes and impacts of scalp tissue expansion in young children.
- To assess potential cranial changes and scar integrity following the procedure.
Main Methods:
- A clinical review of 15 children who underwent scalp tissue expansion between May 2002 and April 2008.
- Mean follow-up duration of 3 years and 5 months, with the average age at initial surgery being 20 months.
Main Results:
- Scar widening was observed in 11 out of 15 patients.
- Slight skull flattening occurred in only two patients, resolving spontaneously.
- Parental satisfaction was high, and children reported no lasting negative memories of the treatment.
Conclusions:
- Scalp tissue expansion is a viable technique for extensive pediatric scalp defects.
- Cranial changes are transient and do not impede brain growth; scar enlargement can be mitigated through double-layer sutures and local reconstruction.
- The procedure yields satisfactory cosmetic results and is well-tolerated by young children.
Introduction:
Tissue expansion is frequently used in scalp repair in children. The short-term complications are well known and described in the literature. Impacts at a distance such as potential deformation of the skull or widening of the scar are not so often presented. The aim of this study is to analyze the results at a distance and the actual impact after scalp tissue expansion in young children.
Materials And Methods:
We clinically reviewed 15 children operated on between May 2002 and April 2008 for scalp tissue expansion.Results Mean follow-up was 3 years and 5 months, and mean age of the patients at the first surgery was 20 months. In 11 cases, we observed a widening of the scar. Only two patients presented with a slight flattening of the skull. All parents were satisfied with the results. Children do not remind or keep no unpleasant memory of the surgical protocol.
Discussion:
Only rare studies focused on very young children. Most of surgeons fear about the consequences of scalp tissue expansion on cranial bone and thus on cerebral growth in children under the age of 2. But it appears that cranial changes in young children are transient with a return to normal within 6 months after removing the implant. Another common problem is the scar enlargement. According to our results and the review of the literature, it seems essential to perform the suture in two layers associated to local reconstruction on the scar to provide the best cosmetic outcomes.
Conclusion:
Tissue expansion remains a good technique to repair large lesions of the scalp in children. The deformation of the skull spontaneously resolves and does not have any consequence on brain growth. The widening of the scar is a common problem in children but can be reduced by suture in two layers associated with local reconstruction. Moreover, young children do not keep any unpleasant memory of this period and are not susceptible to social pressure.
