Tissue expanders in reconstruction of maxillofacial defects

Abstract

Tissue expansion in its natural ways had fascinated man from prehistoric times itself. But tissue expansion for medical purposes was first tried and reported only in the early half of twentieth century. Presently the principle of tissue expansion is being used in reconstruction of many hard and soft tissue defects of larger dimension, which were previously regarded as great challenge for maxillofacial and plastic surgeons. Making use of the viscoelastic nature of the skin, considerable amount of tissue expansion based tissue engineering is possible in the maxillofacial region. Here we present a case of a facial scar of large dimension with a central oro cutaneous fistula developed as a result of facial artery blow out in a 24 year old female for which esthetic correction was done using the excess tissue obtained from tissue expansion. In this case where other methods of reconstruction such as local flaps, free flaps and normal tissue grafts were assessed to be non viable, tissue expansion was found to be an apt solution for esthetic reconstruction.

Keywords: Fistulous tract; Scar tissue; Tissue expander; Tissue expansion.

Fig. 1

Frontal view (pre Op)

Fig. 2

Profile view (pre Op)

Fig. 3

Rectangular type of tissue expander used

Fig. 4

Subplatysmal dissection

Fig. 5

Tissue expander in subplatysmal plane

Fig. 6

Tissue after 1 month of periodic expansion

Fig. 7

Expanded tissue after 2 months

Fig. 8

Points marked for traspositioning

Fig. 9

Marking for excision of scar

Fig. 10

Excision of scar tissue

Fig. 11

The expanded flap

Fig. 12

Capsule around the expander

Fig. 13

Scoring of the capsule

Fig. 14

Back cut for flap advancement

Fig. 15

Immediate post Op

Fig. 16

Viable flap with adequate bulk at 1 week post op review

Fig. 17

Frontal view 1 month post op

Fig. 18

Lateral view 1 month post op

Fig. 19

Four months post op