title: Soft tissue expansion and cranioplasty: For which indications?
abstract: OBJECTIVE
  The aim of this study was to better define indications for scalp tissue expansion before cranioplasty, and to describe our methodology for calculate the surface of tissue needed, by combining a preoperative analysis of both the size of the defect and the quality of skin above.
  
  
  METHODS
  A retrospective analysis of patients who underwent expansion before cranioplasty between 2009 and 2015 was conducted. Information was collected on the etiology, size and location of the defect, and reasons of skin contracture. Data concerning expansion and cranioplasty were reviewed.
  
  
  RESULTS
  Among 47 patients who underwent operation for cranioplasty, five (10.6%) required previous scalp tissue expansion. The etiology of the bone defect was tumoral in three cases, posttraumatic in one case, and a decompressive craniectomy in one case. The mean surface of the bone defect was 69.6 ± 18.7 cm(2). The locations of the defects were fronto-temporo-parietal, frontal, temporo-frontal, on the vertex, and occipital. The cause associated with the skin contracture was an infection in four cases and a delayed cranioplasty in one case. A round-profile expander and a custom-made porous hydroxyapatite implant were used for all patients.
  
  
  CONCLUSIONS
  The accurate assessment of tissue needed before cranioplasty is as essential as the choice of the material used for bone reconstruction. After previous infected cranioplasty or delayed reconstruction of large defects, scalp tissue expansion should be proposed.
authors.affiliation: Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France. Electronic address: raphaelcarloni@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Carloni
authors.affiliation: Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.
authors.forename: B
authors.initials: B
authors.lastname: Hersant
authors.affiliation: Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.
authors.forename: R
authors.initials: R
authors.lastname: Bosc
authors.affiliation: Department of Neurosurgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.
authors.forename: C
authors.initials: C
authors.lastname: Le Guerinel
authors.affiliation: Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Meningaud
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000737:chemistry; D003286:Contracture / Q000601:surgery; D056424:Decompressive Craniectomy / Q000379:methods; D017886:Durapatite / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone / Q000601:surgery; D010294:Parietal Bone / Q000601:surgery; D010347:Patient Care Planning; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D012535:Scalp / Q000601:surgery*; D012886:Skull / Q000293:injuries / Q000601:surgery*; D012888:Skull Neoplasms / Q000601:surgery; D013530:Surgical Wound Infection / Q000601:surgery; D013701:Temporal Bone / Q000601:surgery; D015626:Tissue Expansion / Q000379:methods*
chemical_list: D001672:Biocompatible Materials; D017886:Durapatite
keywords: Calvarial reconstruction; Cranioplasty; Expander; Scalp defect; Tissue expansion