Calvarial deformity and remodeling following prolonged scalp expansion in a child

A main concern in the use of scalp tissue expansion in the pediatric population has been the risk of skull deformation. Little is known about the long-term effects of tissue expansion on the skull and the ability of the skull to remodel following removal of the tissue expander. We report a recent case in which a 5-year-old boy had a fully inflated tissue expander retained under the scalp for a 15-month period. At surgery for removal of the implant the patient was noted to have a profound skull deformity characterized by severe calvarial depression and ridging. The patient underwent scalp reconstruction. Follow-up at 6 months revealed nearly complete remodeling of the skull with minimal visual deformity. This case demonstrates not only the profound bony deformity that can result from tissue expansion, but also the striking ability of the pediatric skull to remodel.