Percutaneous Mesh Expansion (PME): A Regenerative Wound Closure Alternative.

BACKGROUND: Puncture wounds in the 1-mm range usually heal without scars. Stacking rows of these punctures offers a scarless method to generate tissue by mesh expansion. We developed a percutaneous mesh expansion (PME) procedure and present our experience for its wound closure application. METHODS: Over a six-year period we applied PME to 65 consecutive patients 58-101 years-old (mean, 72) with 67 full thickness calvarial defects 2.5x3-7x8cm (mean, 14cm2) that would have all required flaps for closure. Thirty-six were still anticoagulated, and 20 had prior scalp resections. After tumescent epinephrine anesthesia, we temporarily approximate the wound by placing it under strong tension. Using 1.1-mm cutting point needles that selectively sever tissues under tension, we inflict rows of staggered alternating punctures over a distance 5X the defect width. This results in 20% expansion of the meshed area, generating the tissue necessary for defect coverage. When the tension is completely released, closure is done with simple sutures or staples. We avoid over-meshing, especially close to the wound edges and performed no undermining or additional incisions. RESULTS: At 6 weeks follow up, all defects were healed with only a straight resection scar. However, of the 10 defects >5x5 cm, five had wound healing delay and three required a small skin graft. No other complication was observed. CONCLUSION: PME is a minimally invasive procedure that harnesses the body's natural capabilities to regenerate across small gaps. It sums these regenerated gaps in a mesh pattern that expands tissues to close complex wounds without flaps or additional incisions. (C)2017American Society of Plastic Surgeons