Tissue expanders for soft tissue reconstruction in the head and neck area--requirements and limitations.

Objectives: The repair of skin defects in the head and neck region still poses a significant problem for many clinicians. Tissue expansion is described as a treatment option providing good color, texture, and thickness match of the expanded skin. Unfortunately, the complication rates for tissue expansion range from 0 to 48 %. Therefore, the purpose of this study was to investigate risk factors for the use of tissue expanders in head and neck reconstructions.
Materials and Methods: Forty-nine patients with skin deficits in the head and neck area underwent tissue expansion. Sixty-two implanted expanders were analyzed regarding the various complications and the success rate.
Results: The success rate of treated patients was 37 (75.5 %) of all 49 included patients. The most frequent cause for the skin deficit was a tumor resection near the tip of the nose followed by skin deficits resulting after craniectomy. Interestingly, a higher number of expanders and a larger volume were significantly associated with a worse outcome. There was a trend of association between larger defect size and failure, too.
Conclusions: The internal tissue expansion is a suitable technique for skin reconstruction in the head and face area. Compared to distant or free flaps, it often offers a better cosmetic outcome. In very large defects (>100 cm(2)) or when more than two expanders are needed, the failure rate increases. In these cases, other treatment options are recommended.
Clinical Relevance: The internal tissue expansion is a suitable technique for skin reconstruction in the head and face area.