Objectives: The scalp provides just a limited amount of excess tissue that directly can be used for reconstruction. The aim of this investigation was to evaluate the technique of soft tissue expansion in this area for the prefabrication of flaps for different indications.

Methods: 49 patients underwent reconstruction procedures using soft tissue expansion of the scalp between 2004 and 2010. Sixty-two implanted expanders were analysed regarding the various complications and the overall success rate.

Indications were cicatricial alopecia (4), calvarian defects with skin deficit (18), scalp (11) and nose (15) defects after cancer resection and a skin defect after radiotherapy (1). In a two-stage operation, first a silicone elastomer expander of 70–340 ml size with injection port was implanted. 3 patients had two and one patient had four expanders implanted. Reaching sufficient skin expansion of 4 cm × 6 cm to 12 cm × 23 cm after 4–16 weeks of expansion, the scalp flap was designed and transferred. The success rate was 37 (75.5%) of all 49 included patients. A higher number of expanders per patient and a larger volume was significantly associated with a worse outcome.

Results: Tissue expansion of the scalp is a suitable method for the reconstruction of scalp and facial defects, if proper expander placement, tissue adapted expansion time and injection intervals and proper flap design are considered. Compared to distant or free flaps they often offer a better cosmetic outcome. In very large defects (>100 cm ² ) the failure rate increases. Other treatment options are recommended in those cases.

Conflict of interest: None declared.