Tissue expansion in the leg: limits and complications in trauma pathology

Subcutaneous tissue expansion in the treatment of skin loss was first introduced by Neuman (1957) and subsequently developed by Radovan (1982) as a means of increasing the amount of tissue available for reconstruction. It takes advantage of the elasticity of the skin and its ability to expand when submitted to traction, thereby increasing its surface area. This is achieved by the temporary subcutaneous insertion of prostheses which are gradually expanded with physiological saline injected percutaneously through a valve. Once the required increase in skin surface has been achieved, the prosthesis is removed. Indications and modalities for the use of expanders in the head and neck (Argenta et al., 1983; Manders et al., 1984) and the breast (Radovan, 1982; Argenta et al., 1983) are now well established, but severe skin loss in the distal part of the leg, particularly if due to trauma and accompanied by exposure of the neural structure, may create serious problems of reconstruction. We therefore found it useful to apply this new technique in this situation, having previously adopted it in other parts of the body and obtained good results which would have been difficult to achieve with traditional techniques.