Introduction: Facial disfigurement or cutaneous defect
reconstruction might not be feasible without the aid of either
skin grafts or local flaps, but they might have poor color and
character match. Although chronic tissue expansion has
succeeded to achieve an additional new skin with good match
but it is not suitable in many cases. Acute Intraoperative
Sustained Expansion (AISE) (rapid expansion) has been
introduced as an alternate technique to aid in wound closure
following the same strategy of preservation of a good tissue
matching but in a single procedure, also when it is combined
with fat grafting in case of contour irregularities, it enhance
the aesthetic outcome.
Patients and Methods: This study included 27 patients
with different facial disfigurements or facial cutaneous defects
[post tumor excision, post-burn contracture release] located
on nose, cheek, temple, or forehead, divided in two groups:
Group A (Expansion group) included 13 patients those were
treated with (AISE) by using total 21 intraoperative expansion
by Foley catheters, five of these patients were managed with
additional fat injection when associated with contour irregularities.
In the other group, B (Flap/Graft group), 14 patients
were managed by local flaps (11 patients) and skin grafts (3
patients).
Results: AISE showed success to gain additional skin
surface area with each expansion site by dissection, expansion,
or both with means of 14.2%, 16.5% and 30.7% of the involved
basic relaxing skin surface area respectively with more aesthetic
reliability if associated with fat grafting in cases with contour
defects. However, expansion sites showed blood collection
in 9,6%, closure under tension in 9,6%, partial wound dehiscence
in 4.8%. Also, the incidence of patients' dissatisfaction
with the results was 23% of cases. Also, the group of local
flaps and grafts cases showed poor color and texture matching
to the surrounding area 25% in local flap cases and 100% in
cases reconstructed by skin grafts, additional facial scars
100% in cases of local flaps, donor site complications and
unsatisfactory imaging in 80% of cases, unnatural facial
distortion 65%, need for second procedure 28%, wound
dehiscence 22%, partial graft loss 33% and flap viability
problems 12%.
Conclusion: Acute intraoperative sustained expansion
could be considered as a reliable reconstructive tool in facial
disfigurement, although it doesn't add skin as much as chronic
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expansion, but it is helpful in assisting closure of wounds
without tension, that might otherwise be problematic, it suits
small to moderate surface area cutaneous defects, it generates
a good matched skin in single procedure, and gives more
aesthetic outcome if combined with autologous fat grafting
in cases with contour irregularities.