'Expansion in-situ' concept as a new technique for expanding skin and soft tissue

Abstract

Techniques for expanding skin and soft tissue are widely used to repair damaged areas since they facilitate the provision of new, additional skin tissue with similar quality, texture and color to that surrounding the defective area. Conventional expansion techniques involve placing expanders under the normal skin adjacent to a lesion. However, these techniques may involve additional incisions, complications with blood supply and 'dog-ear' deformities and may result in a low utilization rate of the expanded tissue. When reconstructing small defects that may not be sutured directly, these shortcomings, particularly the requirement to make additional incisions, limit the application of conventional techniques. The current study presents a novel approach to expansion called the 'expansion in-situ' technique. In this technique, the lesion is used as the center for expansion and expanders of optimal size are implanted under the lesion and surrounding normal soft tissue. Following expansion, the damaged area is excised directly. In order to avoid poor healing of the incision made during expander implantation, the overlapping suturing of both cut sides is conducted. This enlarges the contact area of both sides of the incision, thereby avoiding incision dehiscence and increasing wound healing during the expansion process. Between August 2006 and July 2011, the expansion in-situ technique was applied in 10 cases involving either nevus excision or scar removal. All 10 cases were treated successfully. Five of the cases were followed up over 1-3 years. The 'expansion in-situ' technique is likely to be useful for avoiding additional incisions and improving the utilization rate of expanded skin flaps.

Keywords: additional incision; cicatrix; expansion in-situ; incision dehiscence; soft tissue expansion.

Figure 1.

Case 1. Facial giant nevus excision with expansion in-situ technique. (A and B) Preoperative frontal and oblique view of a 16-year-old female patient presented with a giant nevus. (C and D) The front and oblique view after 7-week expansion in-situ. (E and F) The early postoperative front and oblique view. (G and H) The front and oblique view one year after the operation.

Figure 2.

Case 3. Removal of nevus in the limbs with expansion in-situ technique. (A) Preoperative view of a 12-year-old boy presented with congenital nevus in right forearm. (B) Design of location of expander; (C) view after the expansion in-situ; (D) appearance one year after surgery.

Figure 3.

Case 5. Excision of facial scar with the expansion in-situ technique. (A) Post-expansion view of a 17-year-old female who presented with a left facial rectangular scar. (B) The oblique view >3 years after surgery.

Figure 4.

Case 9. Elimination of facial scar with expansion in-situ technique. (A) Preoperative view of a 30-year-old patient presented with a left facial scar. (B) De-epithelialization of the incision of implanting the expander in the operation. (C) The dermal flap on both sides of the incision and the overlapping staggered suture was made. (D) The lateral view after 8-week expansion in-situ; (E) the early postoperative view.

Figure 5.

Expansion in-situ under various lesions. (A) Expansion under a giant nevus. (B) Expansion under scattered lesions. (C) Expansion under a tattoo of an irregular shape. (D) Expansion under a scar that was unable to be excised and closed directly.