Sagittal synostosis after excision of congenital pigmented
nevus of the scalp: a possible complication of the tissue expansion
Received: 17 February 2015 /Accepted: 19 April 2015 /Published online: 27 May 2015
Springer-Verlag Berlin Heidelberg 2015
Abstract We report a case of sagittal synostosis that was
detected because of cranial deformity 5 years after a congen-
ital pigmented nevus of the scalp was resected using the tissue
expansion (TE) technique. Currently, no case report describes
the association between TE and craniosynostosis. To explain
the mechanism of the craniosynostosis in the present case, we
considered that the area of placement, number of expanders,
injection schedule, age at operation, or a combination of these
may have been responsible for early suture fusion.
Considering that complete fusion of the sagittal suture
was observed on the postoperative computed tomogra-
phy but that the compensatory change of the cranial
shape was relatively minor, we speculated that the
changes in the patient’s skull could have been second-
ary (late-onset) sagittal synostosis caused by the surgery.
Because the deformity in secondary craniosynostosis is rela-
tively minor, it may be overlooked by some surgeons. We
recommend careful placement of the expander and long-
term follow-up, especially in infants.
Level of Evidence: Level V, risk/prognostic study.
Keywords Sagittal synostosis
The tissue expansion (TE) technique is useful for covering
large skin defects that occur after tumour or scar resection.
Since the pioneering work by Radovan , TE has been in
widespread use and is a current fundamental technique in
plastic and reconstructive surgeries.
Complications such as infection or exposure of the expand-
er after TE are well known, and cranial deformity after ex-
pander removal has also been reported, especially in the pae-
We report a case of sagittal synostosis detected because of
cranial deformity that occurred 5 years after a congenital
pigmented nevus of the scalp was resected using the TE tech-
nique. Late-onset (secondary) craniosynostosis after TE has
not been reported previously but may be a possible complica-
tion of extensive scalp surgery. In this report, we present the
details of the case and discuss the relationship between TE
surgery and craniosynostosis in the present patient.
A 2-month-old girl was referred to our department for the
treatment of a large congenital pigmented nevus on her scalp.
On examination, the nevus was 7×8 cm in diameter (Fig. 1).
After the patient’s family was informed of the aetiology and
treatment options, prophylactic excision was suggested for the
prevention of subsequent malignant changes. Because of the
large nevus, TE was indicated as the reconstruction technique
after the resection.
The first stage of the surgery was performed when the
patient was 1 year old. Under general anaesthesia, two tissue
expanders were inserted subgaleally in the parietal and tem-
poral regions. No cranial deformity was noted at this stage.
This manuscript was orally presented at the 30th Annual Meeting of
Japan Society of Cranio-Maxillofacial Surgery.
* Tamada Ikkei
Department of Plastic and Reconstructive Surgery, Tokyo
Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu
City, Tokyo 183-8561, Japan
Eur J Plast Surg (2015) 38:491–494