Forehead deformities after tissue expansion: Retrospective analysis and recommendations

Area of Science:

• Plastic Surgery
• Craniofacial Reconstruction
• Tissue Expansion

Background:

• Tissue expanders are utilized in craniofacial reconstruction but can lead to bone deformity and resorption.
• Post-extraction normalization of cranial bone changes is not always complete.
• Persistent forehead deformities following tissue expansion require investigation into causative factors.

Purpose of the Study:

• To identify potential factors contributing to persistent forehead deformities after tissue expansion.
• To analyze clinical and demographic data associated with cranial bone changes post-tissue expansion.

Main Methods:

• Retrospective review of 67 patients undergoing forehead tissue expansion (2011-2015).
• Comparison of pre- and post-operative photographs by two plastic surgeons.
• Statistical analyses including Fisher exact, chi-square, Student t tests, and logistic regression.

Main Results:

• Forehead changes occurred in 41.8% of patients post-tissue expansion.
• Significant differences noted in total injection volume and expansion period between patients with and without forehead changes.
• Age, sex, indication, follow-up time, and post-operative pressure bandage use were not significantly correlated with forehead changes.

Conclusions:

• Recommendations for optimal tissue expansion include using the largest base dimension expanders, rapid expansion, and avoiding overexpansion.
• No proven benefit of post-operative pressure bandages was found for preventing skeletal changes.
• These findings aim to minimize persistent deformities in cranial reconstructions using tissue expanders.