Applicability of self-inflating tissue expanders in pediatric
patients with head and neck defects
Gokce Unal Yıldıran
Muhammed Nebil Selimoglu
Received: 21 August 2014 /Accepted: 28 October 2014 /Published online: 18 November 2014
Springer-Verlag Berlin Heidelberg 2014
Background Self-inflating tissue expanders have been used
successfully in breast reconstruction, alopecia, scars, and
anophthalmos. The expanders contain an osmotic active hy-
drogel and a silicon shell. The purpose of this study was to
analyze our clinical experience using self-inflating tissue ex-
panders in the treatment of alopecia and cleft palate defects in
Methods Twenty-eight self-inflating tissue expanders were
used in 13 patients with alopecia or large cleft palate defects.
Expander dimensions were determined by the size of the
defect in the scalp and by using a sizer for the palate. In some
patients, it was necessary to use more than one expander. A
visual analog scale (VAS) and Children’s Hospital of Eastern
of Ontario Pain Scale (CHEOPS) were used to determine pain
Results Sufficient tissue was gained in nine patients (69.2%)
and 11 of the 16 defects were repaired successfully (68.75 %).
We observed four implant extrusions as a major complication
(14.2 %). Three of these four extrusions were seen in cleft
palate expansions. Pain levels were as low as 5 points with
CHEOPS in patients younger than 5 years old and 40 mm with
VAS in patients older than 5 years of age.
Conclusions Self-inflating tissue expanders comfortably en-
sure sufficient tissue in patients with alopecia; however, there
is high risk of extrusion in cleft palate applications.
Level of Evidence: Level V, therapeutic study.
Cleft palate defect
Tissue expansion has become a popular treatment method in
many congenital and acquired defects in both adults and
children in recent years [1, 2]. Traditional tissue expansion
was first introduced into clinical practice by Neumann , and
the first self-inflating expander, with hyperosmotic fluid, was
introduced by Austad .
Self-inflating tissue expanders are structures that have the
capability of swelling at a constant speed; they are known to
inflate within a certain period due to their osmotic active
hydrogels. They are made from vinylpyrrolidone and methyl
methacrylate, which are also used in contact lenses. The self-
inflating tissue expander itself is only about 10% of its final
volume, and it has a silicon shell exterior that limits overswelling
(Fig. 1). The shell also contains small pores and due to these,
controlled absorption of body fluids is provided .
In this study, we aimed to present our experiences with self-
inflating expanders in head and neck defects in a pediatric
population. We retrospectively examined advantages, disadvan-
tages, failures, successes, and complication rates of self-inflating
expanders in the treatment of cleft palate and scalp defects.
Material and methods
From 2010 to 2013, 13 patients (ranging in age from 9 months
to 12 years; female-to-male: 5 to 8) with alopecia or wide cleft
palate defects were admitted by our clinic. The defects were
reconstructed with a total of 28 self-inflating tissue expanders.
Rectangular- and cylindrical-shaped expanders (Osmed,
Ilmenau, Germany) were used. Expander dimensions for scalp
defects were determined by the size of the defect while di-
mensions for palatal defects were determined by special sizer.
The patients were selected for using self-inflating tissue ex-
panders according to dimension of defect area. The patient
M. Karamese (*)
G. U. Yıldıran
M. N. Selimoglu
Department of Plastic Reconstructive and Aesthetic Surgey,
Faculty of Medicine, Selcuk University, Konya, Turkey
Eur J Plast Surg (2015) 38:25–30