Indications and Limitations of the Use of Intraoperative Expansion for Treatment of Scalp Defects

Abstract

　　Primary closure of scalp defects is sometimes difficult because of low extensibility, especially with a history of repeated operations, infections, and the use of artificial materia. We prefer to use intraoperative tissue expansion using a Foley catheter for closing scalp wound. We evaluated its usefulness through retrospective analysis of 36 consecutive patients who were treated with this procedure. The patients（average: 43.8 years old）included 19 tumor, 13 post-neurosurgical, and four scarring alopecia patients. We routinely placed a 20-Fr Foley catheter into the sub-or supra-periosteal pockets, and expand the scalp with 10 to 30 ml of saline in a cyclic loading manner（5 minutes inflation and 3 minutes deflation）. After expansion, the surgical wounds were closed. The average diameters of the defects was 30.8 mm（range: 12 to 52 mm）. All wounds were successfully closed; however, one patient（2.8%）presented wound dehiscence and five patients（13.9%）presented postoperative scarring alopecia. Intraoperative expansion is considered a safe and effective method for treatment of scalp defects; however, well-vascularized tissue transfer or chronic expansion are recommended for complex cases who present a history of repeated operations, infections, and radiation therapy