title: Immediate and early tissue expander placement for acute closure of scalp wounds.
abstract: 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.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Wang Ambulatory Care Center 435, 55 Fruit St, Boston, MA 02114, USA. aturko@partners.org
authors.forename: Arthur
authors.initials: A
authors.lastname: Turko
authors.forename: Gennadiy
authors.initials: G
authors.lastname: Fuzaylov
authors.forename: Vasyl
authors.initials: V
authors.lastname: Savchyn
authors.forename: Daniel
authors.initials: D
authors.lastname: Driscoll
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000601:surgery*; D002648:Child; D062109:Dermatologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012535:Scalp / Q000293:injuries* / Q000601:surgery; D012878:Skin Neoplasms / Q000601:surgery*; D013997:Time Factors; D015626:Tissue Expansion / Q000295:instrumentation / Q000379:methods*; D015625:Tissue Expansion Devices; D016896:Treatment Outcome; D055815:Young Adult