"Decoding a Decade: The Daring Dance of Over inflation in Tissue Expanders – Unveiling Our Unique Journey."

Abstract

Background: Reconstruction of large scalp defect like post burn alopecia, post traumatic alopecia and congenital naevi require not only well-vascularized skin but also hair bearing scalp for better aesthetic outcome. Tissue expansion has always been the valuable reconstructive option in scalp reconstruction and is superior to any other option as it provides hair-bearing scalp. We have changed the traditional way of tissue expansion by using over expansion to two to three times of its recommended expansion to prevent multiple expansions. Methodology: This prospective case series was conducted from January 2013 - December 2022. Patients requiring scalp expansion for reconstruction of post burn alopecia , congenital melanotic naevi and post traumatic alopecia were included in this study. Flap advancement for covering the percentage area of the scalp defect was assessed as the outcome. Results: 13 patients were included, 6 (46%) patients required 2 expanders and 7(54%) patients required single tissue expander. Average flap advancement was 9 cm. Average tissue expansion was 650 ml, over expanded twice to thrice the recommended volume. No patient had any expander complication, wound breakdown or flap necrosis. Hair density was adequate on visual analogue scale. Conclusion: two to three times over expansion in tissue expander is valuable and safe tool for covering large area of alopecia without the need of expansion multiple times. Keywords: Tissue expansion, scalp alopecia, post burn scalp defects, congenital melanotic nevus scalp