Custom-made tissue expanders in reconstructive surgery for challenging skin defects

Background: Tissue expansion is a simple yet versatile surgical technique. Skin defects come in a variety of shapes and dimensions, and in specific reconstructive situations, the catalogued tissue expanders may be of limited suitability producing expanded skin that is not readily compatible with the defect leading to additional scarring and unsatisfactory results. In patients with specific requirements, we have successfully used specially designed tissue expanders to facilitate the reconstruction with reduced morbidity. The aim of the study was to present our experience, indications and outcome of custom-made tissue expanders in resurfacing defects in areas with limited tissue availability. Methods: Thirty-two textured custom-made tissue expanders were used in 16 patients for skin defects. Indications included eight traumas and eight congenital defects. Custom-made tissue expanders with specified locations for the valves were used in combination with advancement of skin to suit specific reconstructive requirements and minimize scarring. Results: Custom-made tissue expanders are ideal in certain circumstances to improve the quality of skin reconstruction with reduced morbidity. Skin necrosis was seen in one smoking patient. Conclusions: In specific reconstructive situations where catalogued tissue expanders are not suitable, custom-made tissue expanders are preferable to optimize results of skin reconstruction with minimal added cost. Level of Evidence: Level IV, therapeutic study.