Percutaneous Mesh Expansion: A Simple and Versatile Technique for Scarless Closure of Facial Wound Defects

 

Introduction:

One-millimeter needle-sized wound in typically heal without scar. Stacking many small gaps in a mesh-expansion pattern can generate a substantial amount of scarless tissue to close defects that would have otherwise required flaps or grafts. We report our 10-years-experience with Percutaneous Mesh Expansion (PME), a very useful scarless alternative for closing facial wound defects.

 

Procedure:

After tumescent anesthesia we place wound edges under extreme tension. Then, with a 1.2mm needle that preferentially severs tensed tissues, we inflict a staggered-alternating pattern of full-thickness punctures down to the restrictive fascia. Each puncture nicks the tight tissues to relieve a tiny amount of tension. We start peripherally and, as mesh expansion relieves tension, we move towards the edges till we achieve a totally tensionless closure. We avoid undermining and meshing close to the edges.

 

Results

Over 10-years, we closed with PME over 4000 Moh’s excision defects of the nose, cheeks, lips and forehead (3cm2-64cm2) that would have otherwise required flaps. The wounds healed uneventfully with a straight-line scar as long as we meshed 8cm/2cm of required tissue gain. Complications were seen when the expansion ratio exceeded 25%. The needle punctures healed without residual scars. Blind needle punctures caused no facial nerve damage. Interestingly, meshed tissues stretch-expand in a two-dimensional pattern that flattens dog ears.

 

Conclusions

PME is a versatile and simple scarless wound closure alternative to the classic “Borrow from Peter to pay Paul”. The sum of tiny gaps generates enough scarless tissue to advance the wound edges beyond their viscoelastic property. PME generates tissue that grows “Paul”.