One Stage Reconstruction of Skull Exposed by Burn Injury Using a Tissue Expansion Technique

• Main Authors: Jae Young Cho, Young Chul Jang, Gi Yeun Hur, Jang Hyu Koh, Dong Kook Seo, Jong Wook Lee, Jai Koo Choi
• Format: Article
• Language: English
• Published: Korean Society of Plastic and Reconstructive Surgeons 2012-03-01
• Series: Archives of Plastic Surgery
• Subjects: Tissue expansion; Burn; Skull
• Online Access: http://www.e-aps.org/upload/pdf/aps-39-118.pdf
• ISSN: 2234-6163; 2234-6171

BackgroundAn area of the skull exposed by burn injury has been covered by various methods including local flap, skin graft, or free flap surgery. Each method has disadvantages, such as postoperative alopecia or donor site morbidities. Due to the risk of osteomyelitis in the injured skull during the expansion period, tissue expansion was excluded from primary reconstruction. However, successful primary reconstruction was possible in burned skull by tissue expansion.MethodsFrom January 2000 to 2011, tissue expansion surgery was performed on 10 patients who had sustained electrical burn injuries. In the 3 initial cases, removal of the injured part of the skull and a bone graft was performed. In the latter 7 cases, the injured skull tissue was preserved and covered with a scalp flap directly to obtain natural bone healing and bone remodeling.ResultsThe mean age of patients was 49.9±12.2 years, with 8 male and 2 female. The size of the burn wound was an average of 119.6±36.7 cm2. The mean expansion duration was 65.5±5.6 days, and the inflation volume was an average of 615±197.6 mL. Mean defect size was 122.2±34.9 cm2. The complications including infection, hematoma, and the exposure of the expander were observed in 4 cases. Nonetheless, only 1 case required revision.ConclusionsSuccessful coverage was performed by tissue expansion surgery in burned skull primarily and no secondary reconstruction was needed. Although the risks of osteomyelitis during the expansion period were present, constant coverage of the injured skull and active wound treatment helped successful primary reconstruction of burned skull by tissue expansion.