Tissue Expanders in Staged Calvarial Reconstruction: A Systematic Review.

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Tissue Engineering

Background:

• Cranioplasties are common reconstructive surgeries.
• Tissue expansion (TE) is less frequently used in staged cranioplasties.
• Optimal soft tissue coverage is crucial for successful cranioplasty outcomes.

Purpose of the Study:

• To systematically review the literature on the use of tissue expansion (TE) in staged cranioplasties.
• To analyze postoperative outcomes and complication rates associated with TE in cranioplasty.
• To describe current practices and identify factors influencing outcomes in staged cranioplasty using TE.

Main Methods:

• Systematic literature review of multiple databases.
• Inclusion of case series, retrospective reviews, and systematic reviews.
• Data extraction on patient demographics, procedure characteristics, and outcomes for 85 patients.

Main Results:

• 85 patients underwent staged cranioplasty with TE, with an average defect size of 122 cm².
• Skin expansion was the most common soft tissue closure method (75.3%).
• Overall infection (3.53%) and local complication (9.41%) rates were low; cerebrospinal fluid leak and hematoma were most common (7.1% each).

Conclusions:

• Tissue expansion (TE) plays a safe and effective role in selected staged cranioplasty cases.
• Adequate soft tissue coverage is essential for successful cranioplasty.
• Higher complication rates were associated with alloplastic calvarial implants and congenital defects.