It is not uncommon that skin defects resulting from excisions of congenital lesions or from trauma to cause wounds that are not amenable to primarily closure (direct skin edge approximation) due to excess tension. These wounds are often covered with split thickness skin grafts in order to achieve adequate and stable wound closure. However, the resulting closures are often aesthetically suboptimal and cause many patients to seek reconstruction. One method available to achieve this goal is tissue expansion.
Tissue expansion is a technique used by plastic surgeons to stretch available adjacent skin so that it can be used to cover a defect. This is achieved by surgically placing a balloon like tissue expander under the skin next to a defect, and then slowly inflating the balloon with water until either the expander is full or the desired amount of expansion is achieved. The patient is then returned to the operating room where the tissue expander is removed and the newly stretched skin is used to cover the defect.
The major drawback to tissue expansion is the amount of time needed to perform the expansion and the frequent trips to see the surgeon post operatively to preform the expansions. Typically, 3 months are allowed to elapse from the time the tissue expander is place before the first intra-office expansion if performed. This allows time for the surgical incision to heal fully and the expander to scar into place. The patient must the return to the office weekly for small incremental expansions, typically over 3-4 months.
Tissue expansion can be utilized in any area of the body, but is best used in areas which overly bone so that expansion forces are directed at the skin. The advantage of tissue expansion is excellent color match and texture of surrounding skin, as well as expansion of hair bearing skin. Consultation with a USF plastic surgeon is an important fist step in tissue expansion evaluation.