Facial Plast Surg 2024; 40(01): 061-067
DOI: 10.1055/s-0043-1767769
Original Research

The Dynamic Changes in Skin Thickness of Forehead during Tissue Expansion

Zhen Song
1   The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
,
Xulong Zhang
1   The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
,
Yihao Xu
1   The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
,
Jianjun You
1   The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
,
Huan Wang
1   The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
,
Ruobing Zheng
1   The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
,
Le Tian
1   The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
,
Junsheng Guo
1   The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
,
Fei Fan
1   The Department of Rhinoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
› Author Affiliations

Abstract

In addition to providing extra flap size, the tissue expansion process also brings changes in flap thickness. This study aims to identify the changes in the forehead flap thickness during the tissue expansion period. Patients undergoing forehead expander embedment from September 2021 to September 2022 were included. The thickness of the forehead skin and subcutaneous tissue were measured with ultrasound before and 1, 2, 3, and 4 months after expansion. Twelve patients were included. The average expansion period was 4.6 months, and the mean expansion volume was 657.1 mL. The thickness of skin and subcutaneous tissue in the central forehead changed from 1.09 ± 0.06 to 0.63 ± 0.05 mm and from 2.53 ± 0.25 to 0.71 ± 0.09 mm, respectively. In the left frontotemporal region, skin and subcutaneous tissue thickness changed from 1.03 ± 0.05 to 0.52 ± 0.05 mm and 2.02 ± 0.21 to 0.62 ± 0.08 mm. On the right side, skin and subcutaneous tissue thickness changed from 1.01 ± 0.05 to 0.50 ± 0.04 mm and 2.06 ± 0.21 to 0.50 ± 0.05 mm. This study measured the dynamic changes in the thickness of the forehead flap during expansion. The thickness of the forehead flap decreased the fastest in the first 2 months of expansion, and the changes in skin and subcutaneous thickness slowed down in the third and fourth months and tended to a minimum value. Additionally, the thickness of subcutaneous tissue decreased greater in magnitude than the dermal tissue.

Ethical Approval

All procedures performed in studies involving the human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


Authors' Contributions

Z.S. was responsible for the design of the study, acquisition of data, analysis, and interpretation of data and drafting the manuscript.

X.Z. participated in the acquisition and analysis of data.

Y.X., J.Y., H.W., R.Z., T.L., and J.G. participated in the discussion and revision of the manuscript.

F.F. is responsible for designing the study, revising the manuscript, and final approval of the version to be published.




Publication History

Article published online:
06 April 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • Reference

  • 1 Pawar SS, Kim MM. Updates in forehead flap reconstruction of facial defects. Curr Opin Otolaryngol Head Neck Surg 2013; 21 (04) 384-388
  • 2 Margulis A, Amar D, Billig A, Adler N. Periorbital reconstruction with the expanded pedicled forehead flap. Ann Plast Surg 2015; 74 (03) 313-317
  • 3 Wang Q, Song W, Hou D, Wang J. Expanded forehead flaps for reconstruction of different faciocervical units: selection of flap types based on 143 cases. Plast Reconstr Surg 2015; 135 (05) 1461-1471
  • 4 Zhu S, Liu Y, Zang M. et al. Facial defect reconstruction using the true scarless pre-expanded forehead flap. J Craniofac Surg 2018; 29 (05) 1154-1160
  • 5 Ellabban MA, Gomaa AA, Moghazy AM, Elbadawy MA, Adly OA. Aesthetic and functional outcomes of thinned anterolateral thigh flap in reconstruction of complex wounds of the upper limb. J Hand Surg Eur Vol 2021; 46 (08) 857-864
  • 6 Vanderkolk CA, McCann JJ, Mitchell GM, O'Brien BM. Changes in area and thickness of expanded and unexpanded axial pattern skin flaps in pigs. Br J Plast Surg 1988; 41 (03) 284-293
  • 7 Ali AK, Abubakar AA, Kaka U. et al. Histological changes of immediate skin expansion of the distal limb of rats. Vet World 2018; 11 (12) 1706-1711
  • 8 Liu S, Ding J, Zhang Y. et al. Establishment of a novel mouse model for soft tissue expansion. J Surg Res 2020; 253: 238-244
  • 9 Pasyk KA, Argenta LC, Hassett C. Quantitative analysis of the thickness of human skin and subcutaneous tissue following controlled expansion with a silicone implant. Plast Reconstr Surg 1988; 81 (04) 516-523
  • 10 Janes LE, Ledwon JK, Vaca EE. et al. Modeling tissue expansion with isogeometric analysis: skin growth and tissue level changes in the porcine model. Plast Reconstr Surg 2020; 146 (04) 792-798
  • 11 Dykes PJ, Marks R. Measurement of skin thickness: a comparison of two in vivo techniques with a conventional histometric method. J Invest Dermatol 1977; 69 (03) 275-278
  • 12 Olenius M, Wickman M, Malm M, Jurell G. Skin thickness in expanded human breast skin. Plast Reconstr Surg 1994; 93 (07) 1428-1432
  • 13 Reali UM, Chiarugi C, De Siena GM, Giannotti V. Sonographic evaluation of dermis and subcutaneous tissue during and after skin expansion. Plast Reconstr Surg 1994; 93 (05) 1050-1055
  • 14 Cao Z, Liu L, Fan J. et al. Aesthetic design of expanded bilateral superficial temporal vascular fascial pedicled flap for repairing maxillocervical scars. Ann Plast Surg 2021; 87 (05) 509-513
  • 15 Ding J, Liu C, Cui J, Liu H, Su Y, Ma X. Efficacy of pre-expanded forehead flap based on the superficial temporal artery in correction of cicatricial ectropion of the lower eyelid. Br J Oral Maxillofac Surg 2021; 59 (01) 58-63
  • 16 Di Mascio D, Castagnetti F, Mazzeo F, Caleffi E, Dominici C. Overexpansion technique in burn scar management. Burns 2006; 32 (04) 490-498