Intraoperative acute tissue expansion revisited: a valuable tool for challenging skin defects.

Background: The efficacy of acute tissue expansion (ATE) in achieving skin closure has been strongly debated. Proponents maintain that ATE is efficacious, whereas critics have argued for lack of supporting scientific data and that ATE is no more effective than skin undermining in closure of surface defects.

Objective: To compare and actually quantify gain in skin length after extensive undermining of skin edges alone or in combination with ATE in skin defects.

Methods: Twenty-one consecutive patients undergoing excision and closure of wounds in certain anatomical areas where primary closure is difficult were studied. Actual measurements of the undermined skin before and after ATE were recorded. Immediate problems and long-term follow-up data were analyzed.

Results: ATE, in addition to undermining, provides 1:1.61 +/- 0.23 more skin on each margin than undermining used alone. It is effective, easy to perform, inexpensive, and reproducible, with clearly quantifiable increments of skin stretch. Long-term morbidity is minimal with excellent cosmetic results.

Conclusion: ATE provides a useful tool for closure of skin defects that are resistant to simple primary closure even when deeply undermined. It is simple and easily performed in an office setting without much preparation or special equipment.