Immediate and Early Tissue Expander Placement for Acute Closure of Scalp Wounds

Background: Scalp tissue expansion is a reliable technique for reconstruction of scalp alopecia and other deformities. However, the conventional practice involves establishing temporary wound coverage before expander placement, expansion, and definitive reconstruction. We propose that immediate (at the time of injury and initial wound debridement, leaving an open wound during expansion) tissue expander placement may be a reasonable approach to the management of full-thickness scalp wounds not amenable to primary closure. Methods: We performed a retrospective chart review identifying all patients who underwent immediate placement of scalp tissue expanders at the Lviv Burn Center (Lviv Medical University Burn Center, Ukraine). Results: A total of 15 patients were identified who received a total of 21 tissue expanders at the time of acute burn treatment. The indications included electrical burn (46.7%), trauma (20%), tumor resection (13.3%), flame burn (13.3%), and chemical burn (6.7%). Of the 21 expanders placed, 4 (19%) complications were reported. There was 1 (4.7%) implant exposure and 3 (14%) implant infections. All of the patients in this series had complete reconstructions after removal of their expanders because all complications occurred toward the end of expansion. Conclusions: Immediate placement of tissue expanders is a reasonable approach that greatly expedites scalp reconstruction. In this series, the complication rate was consistent with or slightly higher than published rates of complications in conventional techniques. Immediate expansion may be especially useful when other reconstructive options (such as free tissue transfer) are unavailable or not feasible.