Repeated tissue expansion in reconstruction of a huge combined scalp-forehead avulsion injury

A 29-year-old woman sustained a severe combined forehead-scalp avulsion injury (20 X 17 cm) in an automobile accident 4 years ago. The skull was covered with split skin-grafts. The defect was successfully removed by the use of simultaneous and repeated tissue expansion of the normal occipital area and the remains of the forehead. The case illustrates the possibility of using large expander volumes (1,700 cc) in the head area and the fact that even narrow skin bridges (2.0 cm above the left eyebrow) can be expanded. The expander shape can be chosen to create a desired flap size and form. Finally, hair thickness and growth can be quite acceptable even after huge expansions of the scalp.