“The Treatment of Complex Extremity Wounds Using External Tissue Expansion: A Case Series”

The goal of wound reconstruction is the approximation of soft tissue and re-establishment of an acceptable appearance with minimal risk of complications. For large wound closure in the extremities, skin graft and flap reconstruction are common treatments but are associated with a variety of complications. Comparatively, tissue expansion can provide the opportunity to reconstruct large wounds with native, durable, and sensate tissue without significant donor site morbidity. Specifically, external tissue expansion is less invasive and avoids complications associated with internal expansion. The authors treated a total of 11 patients with varying extremity wound types and sizes with an external tissue expansion device (DermaClose ®). Patient age ranged from 18 to 68 with an average age of 43.7 years (SD ± 13.1 yr). Average wound surface area was approximately 235 cm2 (SD =±135.3 cm2). Device(s) were affixed and left for 7-11 days before closure of the wounds. Outcomes were assessed at 2-36 weeks post-operative follow up. All wounds were fully closed after treatment without need for secondary reconstructive procedures. No patients experienced major complications. All patients demonstrated intact sensation within the area of reconstruction equivalent to surrounding tissues. External tissue expansion is an excellent treatment option in the algorithm of extremity reconstruction, as it is efficacious and associated with lower complication rates compared with internal tissue expansion, skin grafts, and flap reconstruction.