الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Trauma, burns and tumors can result in significant disfigurement in forehead. The management of these problems depends on the location and extent of the lesion.
The reconstruction of forehead was achieved using simple techniques like skin grafts and local transposition flaps. Later on, more sophisticated methods, like free tissue transfer, were employed. The disadvantages of these methods (graft retraction, donor side morbidity, graft loss, suboptimal aesthetic results) favored the development of another reconstructive method, the tissue expansion.
Skin expansion constitutes an excellent option in the reconstruction of forehead.
This work aimed to study and assess the use of tissue expansion for reconstruction of forehead and included 15 patients presented by various cutaneous lesions and they were operated upon in Alexandria University Main Hospital and Sporting Students’ Insurance Hospital.
Sixteen expanders were inserted, the period of study extended for 3 years from April 2009 to April 2013, 8 cases had post burn scars (8 expanders), , 4 cases had post traumatic scars (4 expanders), 2 cases had post hemangioma management scars (3 expanders) and 1 case had congenital melanocytic nevus (1 expander).
Tissue expansion is a two staged procedure; the first was to apply the expander in a healthy tissue under good soft tissue coverage to increase the mitotic activity of the skin to produce a flap for coverage of the scarred area.
The operation was done under general anesthesia and complete aseptic technique, para-lesional incision was done with a pocket for the expander application and either internal or external reservoirs were used with proper drainage and wound closure in two layers (the galea and the skin).
Inflation started soon when wound was stable till the desired flap length was obtained and proceed to the second stage where the expander was removed and replacement of the unwanted tissues was done by advancement or designing a flap.
Follow up of the patients was done, data were collected and results were obtained for a year.
Reports of complications in the use of tissue expansion are numerous, in this study Complications were classified as during insertion and expansion phase complications (e.g. infection and hematoma), after reconstruction complications (e.g. anterior hair line asymmetry and eye brow ptosis) and late complications (e.g. hyperpigmentation, scar widening).
As regards patients’ satisfaction, an evaluating objective scoring system which determines if results were satisfactory (excellent, very good, good and fair) or not satisfactory (poor) and results were 93.3% (14 cases) who were with satisfactory results. And another subjective assessment by binary quiz of either patient is satisfied or not about the results were done and results were 86.7 % (13 patients) Satisfied and 13.3 % (2 patients) not satisfied.