A single center experience of craniofacial tissue expansion and reconstruction

Tissue expansion is a versatile technique for craniofacial soft tissue defects. It has been extremely useful to restore the form and function along with good esthetics that were otherwise unobtainable.

To review the use of tissue expansion in the craniofacial region, with particular emphasis on indication, site, days, volume of the defect and tissue expansion used along with complications.

Retrospective review of data on 18 expanded flap reconstructions performed in 14 patients during the period 2008-2013. Tissue expanders were placed on a subcutaneous plane above the fascia and inflated weekly. The expanded skin was used as a transposition flap for the reconstruction. Data were collected from archival records and tabulated in SPSS. Descriptive statistics, Kruskal-Wallis and Mann-Whitney tests were applied as required and a P ≤ 0.05 was taken as significant.

Trauma contributed to greater number of defects (57.1%). The most common defect occurs in face/cheek compartment (57.15%) followed by nose (35.71%). Owing to ease of access and better results, more expanders have been placed in cheek (50%), followed by neck (33.33%). The mean defect size was 2983.58 ± 828.27 mm(2), required 32.14 ± 6.31 days, 335.6 ± 156.51 ml in 5.29 ± 1.5 cycles of tissue expansion. The mean rate of expansion was 59.17 ± 16.27, 69.11 ± 30.19 and 62.6 ± 25.75 for forehead, face/cheek and neck cases respectively (P = 0.873).

Laxity of skin appears to be a good indicator of the rate of the expansion. The most favorable site for tissue expansion is cheek followed by neck. The study also shows that tissue expansion is an efficient and valuable technique for reconstruction of large craniofacial skin defects.