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February 1993

The Combined Use of Immediate Intraoperative Tissue Expansion and Meshing Technique

Author Affiliations

Baylor College of Medicine, Houston, Tex; Rush-Presbyterian—St Luke's Medical Center, Chicago, Ill

Arch Dermatol. 1993;129(2):152-153. doi:10.1001/archderm.1993.01680230036004

REPORT OF A CASE  A 57-year-old white man presented with a squamous cell carcinoma on the left shoulder, measuring 4.5 × 5.0 cm (Fig 1). The tumor was excised with pathologically free margins, resulting in a surgical defect measuring approximately 5.5 × 6.0 cm. The wound was widely undermined in all directions. Since wound tension necessary to obtain a primary closure was unacceptable, various options for wound closure were considered.

THERAPEUTIC CHALLENGE  In considering various reconstructive options for this defect of the left shoulder, various flaps were considered as well as full- and partial-thickness skin grafting. Because the shoulder area is one of significant movement and tension, a flap would have a high probability of necrosis or dehiscence. A skin graft requiring immobilization of the shoulder would be impractical for this patient.

SOLUTION  Immediate intraoperative tissue expansion1 offered the possibility of achieving a primary wound closure; however, using the technique

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