DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20195505

Tissue expansion as an aesthetic alternative for facial resurfacing: a single centre series of 92 patients

Neeraj K. Agrawal, Aditya N. Choudhary, Preeti Agrawal

Abstract


Background: The visibility, vulnerability and social stigmata of facial scars whether by burn, nevi or trauma can be compelling for the patient as well as challenging for the surgeon. Restoration to normal form and aesthetics require tissue replacement which has good colour and texture match and produce minimal visible scarring.  Although many other options are available for a given defect, tissue expansion offers the best alternative which meets almost all the criteria of an ideal procedure.

Methods: Among 92 patients with deformities over various facial subunits were operated and expanders 50 ml to 300 ml inserted subcutaneously adjacent to the scar. Prior planning, accurate measurement and choice of ideal expander is extremely important. A precise and practical method of calculation for determination of amount and duration of expander was used. Any secondary deformity to adjoining vital structures was avoided.

Results: Results were meticulously and critically analyzed. Different shapes, dimensions and volume of expanders were used depending on the anatomical site which was to be expanded. A total of 118 expanders were inserted in 92 patients. The average volume of tissue expanders used was 170.33 ml. Majority of the expanders used had volume of 200 ml (62.71%). Post-expansion volume was 240.67 ml and the over expansion done was 41.3% over the pre-expansion volume of 170.33 ml. Surgical outcome and cosmesis was assessed by the patient’s perspective and was considered fair by 57.61% patients.

Conclusions: The study underlines the clinical application, reasons for overexpansion as well as shortcomings and complications of tissue expansion.


Keywords


Aesthetics of face, Facial burns, Facial scars, Overexpansion, Tissue expander calculation, Tissue expansion

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References


Neumann CG. The expansion of an area of skin by progressive distention of a subcutaneous balloon: use of the method for securing skin for subtotal reconstruction of the ear. Plastic Reconstr Surg. 1957 Feb 1;19(2):124-30.

Radovan C. Tissue expansion in soft-tissue reconstruction. Plastic Reconstr Surg. 1984 Oct;74(4):482-92.

Argenta LC, Watanabe MJ, Grabb WC. The use of tissue expansion in head and neck reconstruction. Ann Plast Surg. 1983 Jul;11(1):31-7.

Manders EK, Schenden MJ, Furrey JA, Hetzler PT, Davis TS, Graham WP. Soft-Tissue Expansion: Concepts and Complications. Plast Reconstr Surg. 1984 Oct;74(4):493-507.

Motamed S, Niazi F, Atarian S, Motamed A. Post-burn head and neck reconstruction using tissue expanders. Burns. 2008 Sep 1;34(6):878-84.

Yang JY, Tsai FC, Chana JS, Chuang SS, Chang SY, Huang WC. Use of free thin anterolateral thigh flaps combined with cervicoplasty for reconstruction of postburn anterior cervical contractures. Plast Reconstr Surg. 2002 Jul;110(1):39-46.

Hudson DA. Maximising the use of tissue expanded flaps. Br J Plast Surg. 2003 Dec 1;56(8):784-90.

Wagh MS, Dixit V. Tissue expansion: Concepts, techniques and unfavourable results. Ind J Plast Surg: offic Pub Assoc Plastic Surg Ind. 2013 May;46(2):333.

Morgan RF, Edgerton MT. Tissue expansion in reconstructive hand surgery: case report. J Hand Surg. 1985 Sep 1;10(5):754-7.

Gibney J. Tissue expansion in reconstructive surgery. Paper Presented at Annual Meeting of the American Society of Plastic and Reconstructive Surgeons. Las Vegas; October:1984

van Rappard JH, Sonneveld GJ, Borghouts JM. Geometric planning and the shape of the expander. Facial Plastic Surg. 1988 Jul;5(04):287-90.

Tan Ö. A practical calculation method for predetermination of amount and duration of expander application. Turk J Med Sci. 2011 Nov 30;41(6):1107-9.

Yangqun L, Yong T, Wen C, Zhe Y, Muxin Z, Lisi X, et al. Reconstruction of facial soft tissue defects with pedicled expanded flaps. Chinese J plastic Surg. 2014 Sep;30(5):326-9.

Fochtmann A, Keck M, Mittlböck M, Rath T. Tissue expansion for correction of scars due to burn and other causes: A retrospective comparative study of various complications. Burns. 2013 Aug 1;39(5):984-9.

Antonyshyn O, Gruss JS, Zuker R, Mackinnon SE. Tissue expansion in head and neck reconstruction. Plast Reconstr Surg. 1988 Jul;82(1):58-68.

Chun JT, Rohrich RJ. Versatility of tissue expansion in head and neck burn reconstruction. Ann Plast Surg. 1998 Jul;41(1):11-6.

Yamin MR, Mozafari N, Mozafari M, Razi Z. Reconstructive surgery of extensive face and neck burn scars using tissue expanders. World J plast Surg. 2015 Jan;4(1):40.

Neale HW, Kurtzman LC, Goh KB, Billmire DA, Yakuboff KP, Warden G. Tissue expanders in the lower face and anterior neck in pediatric burn patients: limitations and pitfalls. Plast Reconstr Surg. 1993 Apr;91(4):624-31.

Mohanty RR, Nayak BB, Patnaik AP, Choudhury AK. Study of Tissue Expansion in the Reconstruction of Nevus and Scars. Ann Int Med Den Res. 2019; 5(4):05-11.

Bascom DA, Wax MK. Tissue expansion in the head and neck: current state of the art. Curr Opin Otolaryngol Head Neck Surg. 2002 Aug 1;10(4):273-7.