Face and neck reconstruction with tissue expansion: Indications and limitations

The tissue expansion technique is advantageous for face and neck reconstructions because it allows for the resurfacing of even wide defects using neighboring skin, which is similar in color and texture and therefore superior to skin obtained elsewhere, thereby surpassing conventional methods. The sites for insertion of the tissue expander are above the SMAS in the cheek and the platysma muscle in the neck. There is a greater tendency towards ectropion when the flaps are expanded vertically than when they are expanded horizontally. This could indicate that horizontal expansion is superior to vertical expansion. In designing expanded flaps, care should be taken to suture in as inconspicuous a manner as possible. From this point of view, the expanded cervicofacial flap is esthetically advantageous for reconstruction of cheek defects because such defects can be covered with a single esthetic unit. Finally, the tissue expander should be placed over the mandible because the firm and rigid support of its base permits optimal expansion.