Tissue expansion in neurosurgical reconstructive technique: case report

BACKGROUND: Various reconstructive techniques using hair-bearing scalp to manage unsightly scalp defects have been described. In 1983, Fonseca and in 1984, Horowitz emphasized the use of galeal-pericranial flaps in scalp wounds with exposed bone. In 1986, Matthews and Missoten described early tissue expansion to close a traumatic defect of the scalp, and in 1990 Kiyono placed tissue expander in a pocket adjacent to the defect that was covered with Marlex Mesh. METHODS: The authors present a case of 23-year-old man with a scalp laceration over a depressed fracture of the skull and a dural tear, after a traffic accident. The repair procedures at another hospital failed, resulting in an area of scalp necrosis with a cerebrospinal fluid (CSF) leak. At our observation, the reconstructive technique using hair-bearing scalp with tissue expander was performed to manage unsightly scalp necrosis. Moreover the neurosurgical treatment was necessary to avoid the complications of the CSF leak. CONCLUSIONS: A 9-year review showed more than 40 patients treated by this technique that allows a pericranial flap of every size. When scalp defects are too large, the tissue expander allows good aesthetic results.