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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(06): 729-739
DOI: 10.1055/s-0042-1751104
Pediatric/Craniomaxillofacial/Head & Neck
Review Article

Tissue Expanders in Staged Calvarial Reconstruction: A Systematic Review

Andrea Y. Lo
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of South California, Los Angeles, California
,
Roy P. Yu
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of South California, Los Angeles, California
,
Anjali C. Raghuram
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of South California, Los Angeles, California
,
Michael N. Cooper
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of South California, Los Angeles, California
,
Holly J. Thompson
2   Wilson Dental Library, Herman Ostrow School of Dentistry of University of South California, Los Angeles, California
,
Charles Y. Liu
3   Department of Neurological Surgery, Keck School of Medicine of University of South California, Los Angeles, California
,
Alex K. Wong 
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of South California, Los Angeles, California
4   Division of Plastic Surgery, City of Hope National Medical Center, Duarte, California
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Abstract

Cranioplasties are common procedures in plastic surgery. The use of tissue expansion (TE) in staged cranioplasties is less common. We present two cases of cranioplasties with TE and systematically review literature describing the use of TE in staged cranioplasties and postoperative outcomes. A systematic review was performed by querying multiple databases. Eligible articles include published case series, retrospective reviews, and systematic reviews that described use of TE for staged bony cranioplasty. Data regarding study size, patient demographics, preoperative characteristics, staged procedure characteristics, and postoperative outcomes were collected. Of 755 identified publications, 26 met inclusion criteria. 85 patients underwent a staged cranioplasty with TE. Average defect size was 122 cm2, and 30.9% of patients received a previous reconstruction. Average expansion period was 14.2 weeks. The most common soft tissue closures were performed with skin expansion only (75.3%), free/pedicled flap (20.1%), and skin graft (4.7%). The mean postoperative follow-up time was 23.9 months. Overall infection and local complication rates were 3.53 and 9.41%, respectively. The most common complications were cerebrospinal fluid leak (7.1%), hematoma (7.1%), implant exposure (3.5%), and infection (3.5%). Factors associated with higher complication rates include the following: use of alloplastic calvarial implants and defects of congenital etiology (p = 0.023 and 0.035, respectively). This is the first comprehensive review to describe current practices and outcomes in staged cranioplasty with TE. Adequate soft tissue coverage contributes to successful cranioplasties and TE can play a safe and effective role in selected cases.

Keywords

plastic surgery - cranioplasty - tissue expander - calvarium

Author Contributions

A.Y.L.: conceptualization, data curation, formal analysis, methodology, project administration, preparing the original draft, and review and editing. R.P.Y.: data curation, formal analysis, investigation, methodology, and preparing the original draft. A.C.R.: data curation, formal analysis, investigation, methodology, and preparing the original draft. M.N.C.: conceptualization, methodology, and preparing the original draft. H.J.T.: methodology and preparing the original draft. C.Y.L.: supervision and visualization. A.K.W.: conceptualization, project administration, supervision, validation, visualization, and preparing the original draft.


Patient Consent

The patient provided written informed consent for the publication and the use of his images.


Prior Presentations

This study was presented as follows:


• The 2020 California Society of Plastic Surgeons Scientific Meeting: August 7–9, 2020.


• American Association of Neurological Surgeons Annual Meeting: April 25–29, 2020.




Publication History

Received: 21 July 2021

Accepted: 25 March 2022

Article published online:
13 December 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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