Changing the Donor Site Selection Concept of Facial Skin Expansion from Pure Healthy Tissue to Defect and Healthy Tissue Combination

Abstract

Facial defect reconstruction is a challenge for plastic surgeons due to unique esthetic and functional properties of the region. Facial tissue expansion provides an ideal reconstruction resource. However, the donor site is limited in the facial region. Thus, a cost-effective expansion management is crucial for an efficient reconstruction. In this article, the evolution of our donor site preference for tissue expansion from pure healthy tissue to a defect-healthy tissue combination is presented. Fifteen patients underwent skin reconstruction with local tissue expansion for facial and cervical defects. The full facial or cervical region including the defect and healthy tissue combination was determined as the donor expansion site. The donor site was not limited only to pure healthy tissue. The largest size rectangular expander suitable for the combined expandable donor site size was placed under the defect and healthy tissue border, paying attention to carry the expander far beneath the defect site. The defect site and most adjacent healthy tissue were expanded simultaneously. Major complications such as infection, hematoma, rupture, or flap necrosis were not observed. The expansion of defect-healthy tissue border presented successful reconstruction results with acceptable scars. In the traditional tissue expansion concept, using a large size expander to provide more abundant flap gain does not comply with the limited size of healthy donor site in the face. Expanding the whole facial region, without restriction of the defect, supplies excess donor tissue area for larger size expander use. Eventually, defect-healthy tissue border expansion with large expanders results in minimum final scar and less tissue loss in flap relocation and enables optimal flap gain. This method can easily be adapted to any tissue expansion site of the body.

Level of Evidence IV

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