Extended Scalp Expansion for Larger Defects Prior to Cranioplasty
Jacob Dinis B.S1, Alexandra Junn A.B1, Kristopher Kahle M.D, Ph.D, Michael Alperovich M.D, M.Sc1
1Section of Plastic and Reconstructive Surgery, Department of SurgeryYale University School of Medicine, New Haven, CT, USA, 2Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
Objective Cranioplasty is necessary in the setting of complex, large soft tissue defects that are further complicated by poor quality regional tissue from previous surgeries, infection, or radiation. Scalp tissue expanders can generate hair-bearing, vascularized tissue and allow for tension-free closure over cranioplasties for optimal aesthetic results. The study aimed to explore the upper limit of scalp expansion that can safely be performed has not been explored. Methods: Patients who underwent scalp tissue expansion prior to 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. Result:s Six patients who underwent scalp expansion in preparation for cranioplasty were identified; 5 were male (83.3%) with a mean age was 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, two were used in the remaining case. Average expander fill volume was 434.3±115 ccs with a mean expansion time of 3.3±1.4 months. Using a previously published formula, mean surface are of expanded tissue was 107.5 ± 24.6 cm2 .Expander infection occurred in one 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%); one patient ultimately required free flap reconstruction. Conclusion:s In cases of extended scalp defects, scalp tissue expansion remains the preferred method for recruiting large quantities of like tissue prior to implant cranioplasty. This series demonstrates that expanders up to 550 ccs are safe and effective in cases of large, complex cranioplasties complicated by smoking history, previous infection, and poor tissue quality. Despite competing literature, remote pedicled or free flaps can be avoided in even larger scalp deficits for an optimized aesthetic result.
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