title: Tissue expanders for soft tissue reconstruction in the head and neck area--requirements and limitations.
abstract: OBJECTIVE
  The repair of skin defects in the head and neck region still poses a significant problem for many clinicians. Tissue expansion is described as a treatment option providing good color, texture, and thickness match of the expanded skin. Unfortunately, the complication rates for tissue expansion range from 0 to 48 %. Therefore, the purpose of this study was to investigate risk factors for the use of tissue expanders in head and neck reconstructions.
  
  
  METHODS
  Forty-nine patients with skin deficits in the head and neck area underwent tissue expansion. Sixty-two implanted expanders were analyzed regarding the various complications and the success rate.
  
  
  RESULTS
  The success rate of treated patients was 37 (75.5 %) of all 49 included patients. The most frequent cause for the skin deficit was a tumor resection near the tip of the nose followed by skin deficits resulting after craniectomy. Interestingly, a higher number of expanders and a larger volume were significantly associated with a worse outcome. There was a trend of association between larger defect size and failure, too.
  
  
  CONCLUSIONS
  The internal tissue expansion is a suitable technique for skin reconstruction in the head and face area. Compared to distant or free flaps, it often offers a better cosmetic outcome. In very large defects (>100 cm(2)) or when more than two expanders are needed, the failure rate increases. In these cases, other treatment options are recommended.
  
  
  CONCLUSIONS
  The internal tissue expansion is a suitable technique for skin reconstruction in the head and face area.
authors.affiliation: Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany. handschel@med.uni-duesseldorf.de
authors.forename: Jörg
authors.initials: J
authors.lastname: Handschel
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schultz
authors.forename: Rita A
authors.initials: RA
authors.lastname: Depprich
authors.forename: Ralf
authors.initials: R
authors.lastname: Smeets
authors.forename: Christoph
authors.initials: C
authors.lastname: Sproll
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Ommerborn
authors.forename: Christian
authors.initials: C
authors.lastname: Naujoks
authors.forename: Norbert R
authors.initials: NR
authors.lastname: Kübler
authors.forename: André
authors.initials: A
authors.lastname: Zimmermann
mesh_terms: D000367:Age Factors; D000505:Alopecia / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D062109:Dermatologic Surgical Procedures / Q000295:instrumentation*; D004867:Equipment Design; D005145:Face / Q000601:surgery; D005260:Female; D006257:Head / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D009669:Nose Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012307:Risk Factors; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000601:surgery; D012886:Skull / Q000601:surgery; D012965:Sodium Chloride / Q000008:administration & dosage; D013529:Surgical Wound Dehiscence / Q000209:etiology; D015626:Tissue Expansion / Q000009:adverse effects / Q000295:instrumentation; D015625:Tissue Expansion Devices / Q000009:adverse effects / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D012965:Sodium Chloride