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PURPOSE:Puncture wounds under 2-mm heal without scars. Stacking rows of 2-mm punctures offers a scarless method to generate tissue by mesh expansion. We describe percutaneous mesh expansion (PME) and present our experience with PME for wound closure.
METHODS:We applied PME to 43 consecutive patients 58-101 years-old (mean, 72) with 44 full thickness calvarial defects 2.5x3-6x7cm (mean, 3.5x4.0cm) that would have all required flaps. Twenty-nine were still anticoagulated, and 18 had prior scalp resections. After tumescent epinephrine anesthesia, we temporarily approximate the wound by placing it under strong tension. Using 1.2-mm cutting point needles that selectively sever tissue under tension, we inflict rows of staggered alternating punctures over an area 5X the defect size. 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 and no additional incisions.
RESULTS:Defects healed with only a straight resection scar. However, of the 6 defects >5x5 cm, 2 required a small skin graft. Aside from 4 cases of delayed wound healing, there were no other complications.
CONCLUSION:Contrary to standard flaps, relaxing incisions, and galea scoring techniques, this novel procedure harnesses the body’s natural regenerative capabilities to achieve a minimally invasive closure of complex wounds without additional scars.