Reconstruction of High-Tension Scalp Defects by the Twizzler Technique: A Retrospective Case Series.

Abstract

Scalp wounds are difficult to close primarily because of the inelasticity of the galea, often requiring adjacent tissue transfer or grafting. It is still debated whether intraoperative tissue expansion can occur on the scalp. We report our experience with the Twizzler technique, a form of intraoperative tissue expansion and load cycling, to achieve primary closure of high-tension scalp wounds. In this case series, scalp defects repaired by the Twizzler were identified and those with minimum 3 month follow-up underwent assessment by physicians and patients. All 50 scalp defects that could not be otherwise closed primarily were repaired successfully with the Twizzler. The average defect width was 2.0 cm (range 0.9-3.9 cm), the average physician aesthetic rating was 3.71 on a 5-point scale (very good; n = 25), and most patients rated the scars as "near normal skin" on the Patient and Observer Scar Assessment Scale 3.0 ( n = 32). Based on the findings of this case series, the Twizzler can be used to repair small and medium high-tension scalp defects after Mohs micrographic surgery. Intraoperative tissue expansion and creep deformation on the scalp is limited, but seemingly possible.