Scalp expansion: Surgical considerations and possible future directions

INTRODUCTION: Repairing large scalp defects has always been a difficult task for plastic surgeons. This is because the requirements of such procedures are two-fold: sufficient soft-tissue coverage is required, and to obtain a satisfactory aesthetic outcome, a sufficient number of covering hairs should be ideally provided. MATERIALS AND METHODS: Based on the author's experience in this repair technique over a 20-year period, this article presents some technical details of scalp expansion, surgical refinements and possible directions for further technical advancement. RESULTS: Data and details on relevant scalp anatomy, expander choice, expander placement, subgaleal undermining, galeotomies and acute scalp expansion are provided. CONCLUSIONS: The author hopes that the above-mentioned details may be of some utility in the complex field of scalp expansion.