Reconstruction of acne keloidalis nuchae using osmotic
tissue expanders—a case series
Received: 19 December 2012 / Accepted: 3 April 2013 / Published online: 21 May 2013
Springer-Verlag Berlin Heidelberg 2013
Background Acne keloidalis nuchae (AKN) is a benign
condition of keloid-like papules on the occipital scalp area.
Treatment for AKN is divided into conservative and surgi-
cal. The use of tissue expander enables preservation of the
hirsute area and thereby achieves a good cosmetic result.
Osmotic tissue expander is a self-filling device, which ab-
sorbs tissue fluids in order to increase skin volume gradual-
ly. So far, the use of osmotic expander for reconstruction of
AKN has not been described. We present our experience
with five consecutive cases of tissue reconstruction using
osmotic expanders in AKN.
Methods Five patients suffering from AKN, median age of
43 years (range 35–50), who were admitted to our depart-
ment between April 2010 and December 2011 underwent
reconstruction using an osmotic tissue expander. All patients
had the lesions for a median of 12 years (range 7–15).
Results In three of the five patients, one expander was used
per patient. In the remaining two, two expanders were used.
In all the cases, the operative and postoperative management
were uneventful with no major complications. A minor
complication included partial extrusion of the expander
(one patient), which caused an earlier conclusion of the
reconstruction, nevertheless with a pleasing result. The
average expansion period was 7 weeks (range 4–9).
During that time, there was a median of one follow-up
visit (range 1–2). Final aesthetic results were satisfactory
in all the cases.
Conclusions Osmotic expander is a reliable tool for tissue
expansion. The main advantages of this device make it
especially suitable for AKN reconstruction. Its main
disadvantages include the inability to control the filling rate
and the need to remove it in case of tissue damage.
Level of Evidence: Level V, therapeutic study.
Keywords Acne keloidalis nuchae
Nape of neck
Acne keloidalis nuchae (AKN) is a benign chronic folliculitis
that manifests as papules and pustules located on the occipital
scalp and the nape of the neck, often with recurrent secondary
infections . Despite the wide variety of theories, the exact
etiology of AKN remains obscure and treatment is therefore
difficult and non-specific. In many cases of AKN, conserva-
tive treatment is not successful. In such circumstances, the
treatment of choice remains complete excision of the lesion. In
the cases where it is not possible to close the lesion primarily,
it is possible to reconstruct the area with a skin graft or leave it
for secondary healing. In order to obtain an aesthetically
satisfactory result, however, the hair in the area has to be
restored. The use of tissue expander has been found to give
the best long-term results .
So far, the use of osmotic tissue expander for reconstruc-
tion of AKN has not been described in the literature. We
shall present our experience with five consecutive cases of
reconstruction of AKN lesions using an osmotic tissue ex-
pander in patients who suffered from chronic AKN, but
were not responsive to conservative treatment.
Material and methods
We carried out our study between April 2010 and December
2011. Five patients, all males, with a median age of 43 years
Y. Gronovich (*)
Department of Plastic and Reconstructive Surgery,
Shaare Zedek Medical Center, Jerusalem, Israel
Eur J Plast Surg (2013) 36:489–494