Scalp reconstruction by tissue expansion: tips and tricks

Scalp reconstruction by tissue expansion: tips and tricks


  • Edoardo Raposio Genova - Chirurgia Plastica Ricostruttiva ed Estetica - Terapia Cura Emicrania Cefalea.
  • Giorgio Raposio


Scalp defects, scalp reconstruction, tissue expansion.


Background and aim: Numerous details regarding preoperative planning of scalp expansion are of the utmost importance for maximizing the results of this procedure. Methods: The purpose of this paper is to describe the tips and tricks useful for obtaining the best results in scalp expansion. Results: Basic concepts and operative technique are discussed and detailed. Conclusions: In scalp reconstruction, the use of tissue expansion allows to obtain successful results, Anyhow, it is mandatory to follow some basic rules, dictated by anatomical, technical, and psychological considerations.


Swanson NA, Argenta LC. Tissue expansion. Adv Dermatol. 1988;3:243-58.

Madison JB. Tissue expansion. Vet Clin North Am Equine Pract. 1989 Dec;5(3):633-42.

Bjornson LA, Bucevska M, Verchere C. Tissue expansion in pediatric patients: a 10-year review. J Pediatr Surg. 2019 Jul;54(7):1471-1476.

Asa'ad F, Rasperini G, Pagni G, Rios HF, Giannì AB. Pre-augmentation soft tissue expansion: an overview. Clin Oral Implants Res. 2016 May;27(5):505-22.

Collins SA, Swanson NA. Chronic tissue expansion. J Dermatol Surg Oncol. 1993Dec;19(12):1090-8.

Krieger Y, Silberstein E, Shoham Y, Bogdanov-Berezovsky A. Tissue Expansion: Still Not Expendable. Isr Med Assoc J. 2017 Feb;19(2):119-120.

Malata CM, Williams NW, Sharpe DT. Tissue expansion: an overview. J Wound Care. 1995 Jan;4(1):37-44.

Marcus J, Horan DB, Robinson JK. Tissue expansion: past, present, and future. J Am Acad Dermatol. 1990 Nov;23(5 Pt 1):813-25.

Rivera R, LoGiudice J, Gosain AK. Tissue expansion in pediatric patients. Clin Plast Surg. 2005 Jan;32(1):35-44, viii.

Teo I, Cairns S, Stephenson AJ. Reverse tissue expansion. Ann R Coll Surg Engl. 2014 Apr;96(3):239.

Hoffmann JF. Tissue expansion in the head and neck. Facial Plast Surg Clin North Am. 2005 May;13(2):315-24, vii.

Lee T, Vaca EE, Ledwon JK, Bae H, Topczewska JM, Turin SY, Kuhl E, Gosain AK, Tepole AB. Improving tissue expansion protocols through computational modeling. J Mech Behav Biomed Mater. 2018 Jun;82:224-234.

Janes LE, Ledwon JK, Vaca EE, Turin SY, Lee T, Tepole AB, Bae H, Gosain AK. Modeling Tissue Expansion with Isogeometric Analysis: Skin Growth and Tissue Level Changes in the Porcine Model. Plast Reconstr Surg. 2020 Oct;146(4):792-798.

Siegert R, Weerda H. Die Hautexpansion. Teil 1: Technische und physiologische Grundlagen [Tissue expansion. Part 1: Technical and physiologic principles]. HNO. 1994 Feb;42(2):124-37.

Johnson TM, Lowe L, Brown MD, Sullivan MJ, Nelson BR. Histology and physiology of tissue expansion. J Dermatol Surg Oncol. 1993 Dec;19(12):1074-8.

Raposio E, Santi P. Computer-aided preoperative planning of tissue expansion. Ann Plast Surg. 1997 Oct;39(4):416-7.

Raposio E, Santi P. Computer planning for breast reconstruction by tissue expansion. Plast Reconstr Surg. 1998 Jun;101(7):1931-3.

Raposio E, Panarese P, Cella A, Gualdi A, Faggioni M, Renzi M, Caregnato P, Santi PL. Effects of topical pharmacologic therapy in cutaneous expansion in reconstructive surgery. Chirurgia. 1999; 12(6): 465-7.

Raposio E, Cella A, Panarese P, Caregnato P, Gualdi A, Santi PL. Quantitative benefits provided by acute tissue expansion: A biomechanical study in human cadavers. Br J Plast Surg. 2000 Apr;53(3):220-4.

Raposio E, Cella A, Caregnato P, Distefano A, Gualdi A, Ricci M, Capello C, Santi PL. Computer-aided preoperative planning of tissue expansion. Minerva Chir. 2001 Oct;56(5):543-5.

Raposio E, Bertozzi N. Quantitative difference of acute intraoperative expansion in various body regions. Eur Rev Med Pharmacol Sci. 2017;21:454-9.

Raposio E, Bertozzi N. Ultrastructural effects of topical dimethyl sulfoxide on collage fibers during acute skin expansion in a human ex-vivo model. Eur J Plast Surg. 2017; 40(4): 271-6.

Raposio E, Santi PL. Topical application of DMSO as an adjunct to tissue expansion for breast reconstruction. Br J Plast Surg. 1999 Apr;52(3):194-7.

Raposio E, Cella A, Renzi M, Caregnato P, Barabino P, Faggioni M, Gualdi A, Santi PL. Clinical evaluation of a new adjuvant pharmacological protocol in breast reconstruction by tissue expansion. Chirurgia. 1999; 12(3): 237-9.

Raposio E, Caregnato P, Distefano A, Gualdi A, Capello C, Santi PL. Computer planning for postmastectomy breast reconstruction by tissue expansion. Minerva Chir. 2001 Apr;56(2):205-8.

Raposio E, Caregnato P, Barabino P, Gualdi A, Orefice A, Spagnolo A, Capello C, Santi PL. Computer-.based preoperative planning for breast reconstruction in the woman with unilateral breast hypoplasia. Minerva Chir. 2002 Oct;57(5):711-4.

Raposio E, Cicchetti S, Adami M, Ciliberti RG, Santi PL. Computer planning for breast reconstruction by tissue expansion: An update. Plast Reconstr Surg. 2004 Jun;113(7):2095-7.

Bertozzi N, Pesce M, Santi P, Raposio E. Tissue expansion for breast reconstruction: Methods and techniques. Ann Med Surg (Lond). 2017 Jul;21;21:34-44.

Bellini E, Pesce M, Santi P, Raposio E. Two-Stage Tissue-Expander Breast Reconstruction: A Focus on the Surgical Technique. Biomed Res Int. 2017 Volume 2017, Article ID 1791546, 1-8

Desai SC, Sand JP, Sharon JD, Branham G, Nussenbaum B. Scalp reconstruction: an algorithmic approach and systematic review. JAMA Facial Plast Surg. 2015 Jan-Feb;17(1):56-66.

Dedhia R, Luu Q. Scalp reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2015 Oct;23(5):407-14.

Laitung JK, Brough MD, Orton CI. Scalp expansion flaps. Br J Plast Surg. 1986 Oct;39(4):542-8. doi: 10.1016/0007-1226(86)90132-3.

Dinis J, Junn A, Kahle K, Alperovich M. Extended Scalp Expansion for Larger Defects During Staged Cranioplasty. J Craniofac Surg. 2022 May 1;33(3):787-789.

Cooper JB, Kim MG, Mohan A, Tobias ME. Decompressive craniectomy with scalp expansion graft using a temporary synthetic skin substitute in the pediatric population: case series and review of the literature. Childs Nerv Syst. 2020 Jun;36(6):1319-1324. doi: 10.1007/s00381-019-04494-5.

Bradford BD, Lee JW. Reconstruction of the Forehead and Scalp. Facial Plast Surg Clin North Am. 2019 Feb;27(1):85-94.

Dong W, Wang H, Fan F. Scalp expansion for giant cutis verticis gyrata secondary to cerebriform intradermal nevus. J Int Med Res. 2020 Dec;48(12):300060520974243.

Brodsky MA, Rezac L, Terella A, Brown M. Tissue Expansion Before Mohs Micrographic Surgery for a Large Scalp Tumor. Dermatol Surg. 2021 Jul 1;47(7):997-998.

Funakoshi Y, Shono T, Kurogi A, Maehara N, Hata N, Mizoguchi M. Intraoperative Tissue Expansion Using a Foley Catheter for a Scalp Defect: Technical Note. World Neurosurg. 2020 Nov;143:62-67.

Kim J. Treatment of Scalp Scars. Facial Plast Surg Clin North Am. 2017 Feb;25(1):83-88

Fowler NM, Futran ND. Achievements in scalp reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2014 Apr;22(2):127-30.

Frechet P. Scalp extension. J Dermatol Surg Oncol. 1993 Jul;19(7):616-22.

Azzi JL, Thabet C, Azzi AJ, Gilardino MS. Complications of tissue expansion in the head and neck. Head Neck. 2020 Apr;42(4):747-762.

Earnest LM, Byrne PJ. Scalp reconstruction. Facial Plast Surg Clin North Am. 2005 May;13(2):345-53, vii.

Raposio E, Adami M, Capello C, Ferrando G, Molinari R, Renzi M, Caregnato P, Gualdi A, Faggioni M, Panarese P, Santi PL. Intraoperative expansion of scalp flaps. Quantitative assessment. Minerva Chir. 2000 Sep;55(9):629-34.

Raposio E, Cella A, Barabino P, Santi P. Ineffectiveness of acute scalp expansion. Plast Reconstr Surg. 1999 May;103(6):1645-9.

Raposio E, Nordström RE, Santi PL. Undermining of the scalp: quantitative effects. Plast Reconstr Surg. 1998 Apr;101(5):1218-22.

Raposio E, Nordström RE. Biomechanical properties of scalp flaps and their correlations to reconstructive and aesthetic surgery procedures. Skin Res Technol. 1998 May;4(2):94-8.

Nordström RE, Raposio E. Scalp extension--a quantitative study. Dermatol Surg. 1999 Jan;25(1):30-3.

Raposio E, Santi PL, Nordström RE. Serial scalp reductions: a biomechanical approach. Dermatol Surg. 1999 Mar;25(3):210-4.

Lago G, Raposio E. Reconstructive options in scalp surgery. Chirurgia 2020 April;33(2):93-9.

Spinzo G, Raposio E. Reconstructive surgery of the scalp: Indications and techniques. Chirurgia. 2020;33(5):249-54.

Raposio E, Nordström RE. Tension and flap advancement in the human scalp. Ann Plast Surg. 1997 Jul;39(1):20-3.







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Scalp reconstruction by tissue expansion: tips and tricks. Acta Biomed [Internet]. 2022 Oct. 26 [cited 2024 Apr. 25];93(5):e2022313. Available from:

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