Tissue expansion constitutes an invaluable tool for+ reconstructions in the craniofacial area and, in this sense, we should be thankful to the authors for their work, as it serves to remind us of the availability of this technique, how to perform it, the indications for it , and possible complications.

On reconstructing facial cutaneous defects the best results are obtained when skin of a similar color and texture is used, and when the aesthetic units of the face are respected. When the tissue next to the defect is insufficient for obtaining the necessary amount of skin for a reconstruction, tissue expansion is an alternative that should be kept in mind.

Tissue expansion produces a net increase in the surface area of the skin. Whether this is produced purely by stretching, or if new tissue is actually formed, has been debated in various publications. On carrying out tissue expansion in skin adjacent to the defect, new skin of a similar texture and color to that which is to be replaced is created. In addition, if in the design of the flap the sensory nerves of the skin are preserved, the sensitivity of the transferred skin will persist.

The appearance of pain, seroma, necrosis through pressure, expander exposure or secondary infection are possible complications.

Among the disadvantages of expansion, of note is the need for surgery in two phases, the duration of the expansion process with the need for repeated visits to inflate the expander, the discomfort that is produced an hour or two after each expansion, and above all the disagreeable inaesthetic aspect at the end of the expansion.

Areas that should not be expanded are those that are not well vascularized, those with local infection, or those where the probability of neoplastic recurrence is high.

Expansion can be used to provide tissue for any area of the head and neck. It has been used for reconstructing ears, noses, lips, and for skin of the neck… It is particularly useful for the reconstruction of the forehead and the scalp where lack of laxity impedes direct closure of the defects. It also allows introducing hair into an area where it has been eliminated through burns or resection. It is especially useful in revision of scars and in treatment of chronically infected wounds, as tissue with increased vascularization connected with tissue expansion is introduced. Expansion has also been used to correct different patterns of male alopecia.

In general, the expansion is carried out until a flap is achieved that is 30 to 50% larger than the defect to be repaired, as the flap always contracts to a certain extent. A secondary follow-up should therefore not be carried out until 3 to 6 months have passed, during which time the expanded and transferred flap will have matured.

F.J. Alamillos Granados

Médico Adjunto
Servicio de Cirugía Oral y Maxilofacial
Hospital Universitario Reina Sofía, Córdoba. España

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