Clinical use of a tissue expander--enhanced transposition flap for face and neck reconstruction

Tissue expanders have been used in reconstructive surgery with increasing frequency, 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. This report describes the use of tissue expanders to enhance the area and vascularity of shoulder skin to provide suitable, ample tissue that can then be used as large pedicled transposition flaps for reconstruction of the face and neck. It is a clinical study based on previous laboratory studies cited that demonstrates that large flaps with very narrow pedicles remain well vascularized and can be transposed to cover very large defects. The tissue expander appears to enhance the vascularity of the flap. The thinning of the dermis and subcutaneous tissue seems to make the donor skin more similar in quality to face and neck skin. These studies suggest that even larger flaps may be developed to supply tissue to resurface the entire face or very large portions of it.