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Cross-section of the inserted tissue expander. The width of the hypothetical functional skin that could be used to cover the defect was defined as the width of the bottom subtracted from the width of the surface, for example, the sum of 2 times the height of the expander is equal to the hypothetical functional skin for a rectangular expander.
Source publication
Background:
Tissue expanders have become established instruments for scalp reconstruction. However, selection of the size of the expander has not been investigated systematically, and it generally depends on the experience of the surgeon.
Methods:
We retrospectively analyzed 21 patients who had undergone treatment for scalp lesions using tissue ex...
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postcraniotomy sur...
Reconstruction of scalp defects can be accomplished by many methods, but larger defects, especially those in which the periosteum is absent or calvarial defects are present, require free tissue transfer. Various methods of scalp reconstruction, as guided by the defect components and size, are presented herein, with a focus on free tissue transfer....
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Citations
... Once no recurrence is observed, aesthetic hair bearing scalp reconstruction especially for young patients is a must. No other tissue in the human body mimics hair bearing scalp, 5 and providing a near normal hair bearing scalp cover, should be final goal as most of SAVM patients are young individuals with major aesthetic concerns. Multiple methods are available for hair restoration from primary closure, rotation and advancement flaps, hair transplant, scalp reduction, scalp expansion and even free tissue transfer. ...
... 7 Scalp with its rich blood circulation, thick overlying tissue and rigid skull bone below is an ideal place for expander placement. 5 Tissue expansion is governed by concepts of biological and mechanical creep that increases mitotic activity and intrinsic extensibility of the native skin. 2,5 Same principals were used in our study. ...
... In our study, in 9 out of 10 cases, rectangular expanders were used as they provided the most efficient expansion. 5 The width of the defect was noted and an expander which could generate extra skin 2.5 times the width of defect was taken. The volume of such expander was calculated to about 5-7 mL/cm 2 of the lesion. ...
Background:
Scalp arteriovenous malformations (SAVMs) are seen in young individuals and skin involvement is common in large SAVMs. They are commonly seen in younger age group too. Pre-operative embolization followed by surgical excision and hair bearing scalp reconstruction with tissue expansion are the treatment of choice. Therefore, proper selection of tissue expander for reconstruction of hair bearing scalp, seems essential. This study evaluated excision of large SAVMs with aesthetic scalp reconstruction.
Methods:
We described management of 10 patients of large SAVMs with cutaneous involvement. All patients underwent pre-op embolization followed by surgical excision and hair bearing scalp reconstruction with tissue expansion.
Results:
All cases of large SAVMs healed well with minor complications.
Conclusion:
While complete surgical excision with extirpation of the nidus is considered as the gold standard treatment, aesthetic hair bearing scalp restoration is also of paramount importance for the patient. This is done by using scalp tissue expansion after proper selection of the expander.
Background:
Secondary cranioplasty is often required following trauma, infection, radiation, or oncologic care, but is complicated by soft-tissue deficits with limited regional options. Scalp tissue expanders can provide hair-bearing, vascularized tissue for tension-free closure yielding optimal aesthetic results. However, the upper limit of safe scalp expansion has not been explored. This study sought to evaluate the efficacy of extended scalp tissue expansion for challenging cranioplasties in a consecutive series.
Methods:
Patients who underwent scalp tissue expansion before cranioplasty were retrospectively identified from a single institution between the years 2017 and 2020. Patient demographics, tissue expansion characteristics, and complications during expansion and after cranioplasty were collected.
Results:
Six patients were identified who underwent staged scalp expansion for cranioplasty; 5 were male (83.3%) with a mean age of 43.8 ± 12.5 years. Indications for cranioplasty included 2 epilepsy-related procedures, 1 oligodendroglioma, 2 infectious processes, and 1 traumatic incident. A single expander was used in 5 cases, whereas 2 were used in the remaining case. The average expander fill volume was 434.3 ± 115 ccs with a mean expansion time of 3.3 ± 1.4 months. Expander infection occurred in 1 case and expander exposure in another, but adequate scalp expansion was still achieved in both. Successful closure over cranioplasty was obtained in 5 cases (83.3%); 1 patient ultimately required free flap reconstruction for soft-tissue coverage.
Conclusions:
In cases of extended scalp defects, scalp tissue expansion remains the preferred method for recruiting large quantities of like tissue before implant cranioplasty.
Globally, there has been a measured response to rationalise elective operating during the Coronavirus disease 2019 (COVID-19) pandemic. In terms of breast cancer care, this has led to a restricted provision of reconstruction with autologous free tissue transfer. A primary concern is the risk of mortality in elective surgery patients who develop COVID-19. The aim of this report is to describe the observed physiological impact of the virus on our patient, and to address how outpatient care after autologous free tissue transfer can be delivered to COVID-19 positive patients.
In March 2020, we performed a bilateral breast reconstruction with a deep inferior epigastric perforator flap and a superficial inferior epigastric perforator flap. The patient became symptomatic on day three post-operatively, tested positive for COVID-19 and was discharged home. Drain and dressing management was continued through the use of telemedicine. Two weeks following the operation, a breast seroma formed that was drained semi-electively in the COVID-19 positive area of the Emergency Department. The patient visited the dressing clinic twice in total and healed after three weeks.
Despite undergoing complex surgery and having pre-operative chemotherapy, our patient suffered a mild form of the virus limited to upper respiratory symptoms. Physiologically we did not see any significant difference to that of the normal post-operative course. This case demonstrates the possibility of managing autologous breast reconstruction patients using telemedicine. Although COVID-19 can complicate, or even be fatal, in the perioperative course, our patient thankfully suffered no discernable negative outcome from her infection.
The SARS-CoV-2 cornovirus disease (COVID-19) pandemic has significantly affected referrals of new suspected cancers from primary care to specialist services in the National Health Service (NHS) across the UK. Amongst the many factors causing delay, such as fear and uncertainty about COVID-19 transmission, reluctance to seek medical attention for cancer sypmtoms and avoiding additional pressure on NHS services, we anticipate a surge in urgent skin cancer referrals to our plastic surgery service as we enter a post-COVID recovery phase. On the basis of previous referral data and statistical forecasting, we share our predicted numbers against our actual number of urgent skin cancer referrals for the COVID-19 period and, based on this analysis, encourage all cancer services to prepare and allocate resources appropriately for the busy months to follow.
Las quemaduras del cuero cabelludo son frecuentes en la infancia, por el derramamiento de líquidos calientes, y en adultos por el retorno de llamas. Las quemaduras profundas o infectadas pueden causar secuelas alopécicas extensas, con repercusión social y psicológica. El tratamiento de las secuelas de quemaduras del cuero cabelludo consiste en la mayoría de los casos en la expansión cutánea; la piel del cuero cabelludo es idónea para la realización de colgajos expandidos. Esta es la única técnica que permite una reparación idéntica al cuero cabelludo original. La elección del número de prótesis, de su forma, su volumen y su localización depende de las características de la piel que se va a tratar y de la piel sana restante; es una técnica exigente, demandante para el paciente y no exenta de complicaciones. A pesar de todo, la expansión del cuero cabelludo es el tratamiento de referencia debido a los excelentes resultados obtenidos. Los mini y los microinjertos capilares, así como la dermopigmentación son métodos adyuvantes útiles para las cicatrices de pequeño tamaño o como complemento de los colgajos expandidos.
Introduction
Aplasia cutis congenita (ACC) is a rare congenital disorder. The purpose of this study was to present outcomes of tissue expander application for scalp reconstruction in extensive ACC.
Patient/Methods
In this retrospective study, medical records were reviewed for six patients who underwent serial tissue expander application for scalp reconstruction in ACC between 2000 and 2015. Patient average age was 14.5 (range, 4–25 years). One of the six cases had frontal bone defect, the others had bone and soft tissue defect at the vertex. In the newborn period, all patients have been managed by split-thickness skin grafts without cranioplasty procedures. After grafting and calvarial regeneration, one (or more) sessions of tissue expanders and scalp flap applications were performed for alopecia and soft tissue correction. Radiologic and clinical examination was performed for complications and outcomes.
Results
Computerized tomography showed intact calvarium with patchy hyperostosis in all patients. The mean size of grafted areas was 69.5 cm2 (range, 32–148.5 cm2). Minimal distal flap necrosis (6 × 1 cm) was observed in one patient. Serial scalp tissue expansion was performed with at least one session in a 1-year interval. One expander was extracted due to exposition and infection. No total flap losses and no calvarial defects were observed during follow-up (mean; 8.6 years). Clinical examination revealed acceptable cosmetic results in all patients.
Conclusion
We advocate late expander scalp reconstruction for management of extensive ACC cases.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www. springer. com/ 00266.
