Indications for Tissue Expansion
Tissue expansion is recommended when local tissues are insufficient to reconstruct a defect or when large areas of skin require restoration.
Common indications include:
- Post-burn skin defects
- Traumatic soft tissue defects
- Large postoperative defects
- Reconstruction following tumor removal
- Congenital skin defects
- Scar contractures and deformities
- Closure of extensive wounds
- Reconstructive surgery of the scalp, face, and neck
Scalp tissue expansion and lateral neck expansion are particularly valuable because they preserve the natural color, texture, elasticity, and hair-bearing characteristics of the skin.
When a scar needs excision
Surgical excision is considered once conservative methods are exhausted: when a scar is wide, depressed or displaces tissue, when it tightens the skin and limits movement, when it sits in a conspicuous place, or when it healed badly because of infection or tension on the wound edges.
Excision does not make a scar invisible: the old scar is replaced by a new, thinner and better-oriented one. The surgeon therefore shows in advance what result can realistically be expected.
Methods and timing
Simple excision suits narrow linear scars. Z- and W-plasty change the scar's direction, breaking up the straight line, and are used in areas of tension and for contractures. Wide scars may require staged excision or tissue expansion. The procedure is performed under local anaesthesia, or general anaesthesia for a large area, and takes from 30 minutes to 2 hours.
A scar must mature first: elective excision is usually planned no earlier than 6–12 months after it forms.
Our patients’ results
Photographs of Helios Medical Center patients, published with their consent. Results are individual and depend on the starting anatomy, age and personal characteristics.
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No scar can be removed completely — skin heals only by scarring. The aim of surgery is different: to make it thin, flat, level with the skin and aligned with natural lines so that it stops being noticeable.
The outcome depends on site, skin type and individual scarring tendency. Results on the face and neck are usually better; in areas of tension — shoulders, chest, back — scars are wider and need more work.
Tell the surgeon before surgery. With a keloid tendency, excision alone often leads to recurrence, so it is combined with prevention: corticosteroid injections, silicone dressings, compression and sometimes early radiotherapy.
The decision is individual, and in some cases the surgeon will advise against excision in favour of conservative management.
Sutures are removed on day 7–14 depending on the area. From the moment it heals and for 6–12 months, silicone gels or sheets are used and tension on the skin in that area is avoided.
Sun protection is essential: ultraviolet light on an immature scar causes lasting pigmentation. The scar's final appearance is assessed after a year.
