Scarred scalp reconstruction with a rectangular expander

Scalp reconstruction is challenging because the scalp is inelastic, stiff, and has hair follicles. Tissue expansion offers aesthetically pleasing outcomes with minimal donor-site morbidity. However, in a scarred scalp, the extent of possible dissection for the expander insertion may be limited and surgeons must make use of the limited scalp tissue. We successfully reconstructed scarred scalps using rectangular expanders. This report presents two cases: a 4× 3 cm chronic defect with widespread scarring and osteomyelitis and an 11× 7.5 cm scar tissue following a skin graft. Tissue expanders were inserted in the subgaleal plane and were inflated by 195 mL and 400 mL over periods of 2 and 3 months, respectively. Subgaleal elevation of a fasciocutaneous flap was achieved with the expanded tissue. The defects were well covered, with good color, texture, and hair-bearing tissue. There were no complications involving the tissue expanders. Rectangular expanders yield more available tissue than round or crescent-shaped expanders. Moreover, since the base of the flap is well defined, the expander can be easily inserted in a limited space. Therefore, rectangular expanders are recommended for the reconstruction of scarred scalps.