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External tissue expansion effectively closed large scalp, forehead defects

The use of an external tissue expander was a safe and effective technique for closing large scalp and forehead defects that would otherwise require skin grafting, according to study results.

Researchers reviewed seven patients (mean age, 70 years; four men) who had undergone extirpation of head and neck malignant neoplasms. These resulted in scalp and forehead defects ranging in greatest dimension from 5 cm x 4 cm to 8 cm x 7 cm. An external tissue expander was used for reconstruction, and clinical factors, defect size and photographs were employed.

The device was in place for 6 to 14 days, with tightening performed one to three times during outpatient visits. Defect sizes were reduced by 50% to 99%; five patients achieved primary closure at the time of device removal. One patient required bilateral advancement rotation flaps; another healed by second intention. One patient, who had poorly controlled diabetes and a 6-cm x 7.5-cm scalp defect that had been previously irradiated, had partial skin loss after device removal. He required a latissimus dorsi myocutaneous free flap for reconstruction. No wound breakdowns resulted at the anchor sites. Two patients had wounds closed in one-layer fashion with staples after primary closure resulted in dehiscence. The wounds dehisced again 1 to 2 weeks after staple removal. A two-layer closure with polydioxanone and polypropylene sutures was used for the remaining patients, with no wound breakdowns.

“This device offers an alternative option for large scalp and forehead defects that would not be amenable to primary closure and would otherwise require skin grafting or free flap reconstruction,” the researchers concluded.

While the device “appears to be appropriate for most patient populations,” the researchers said, “caution should be exercised in patients in whom local tissue vascularity may be compromised.”