• Kimberly S Khouri, Eufemiano Cardoso, and Roger K Khouri.
• New York, N.Y.; and Miami, Fla. From the New York University School of Medicine; the Miami Hand Center; and the Miami Breast Center.
• Plast. Reconstr. Surg. 2018 Feb 1; 141 (2): 451-457.

BackgroundPuncture 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. The authors developed a percutaneous mesh expansion procedure and present their experience for its wound closure application.MethodsOver a 6-year period, the authors applied percutaneous mesh expansion to 65 consecutive patients aged 58 to 101 years (mean, 72 years) with 67 full-thickness calvarial defects ranging in size from 2.5 × 3 cm to 7 × 8 cm (mean, 14 cm) that would have all required flaps for closure. Thirty-six were still anticoagulated, and 20 had prior scalp resections. After tumescent epinephrine anesthesia, the authors temporarily approximate the wound by placing it under strong tension. Using 1.1-mm cutting point needles that selectively sever tissues under tension, the authors inflict rows of staggered alternating punctures over a distance five times the defect width. This results in 20 percent expansion of the meshed area, generating the tissue necessary for defect coverage. When the tension is completely released, closure is performed with simple sutures or staples. The authors avoid overmeshing, especially close to the wound edges, and perform no undermining or additional incisions.ResultsAt 6-week follow-up, all defects were healed with only a straight resection scar. However, of the 10 defects larger than 5 × 5 cm, five had wound healing delay and three required a small skin graft. No other complication was observed.ConclusionsPercutaneous mesh expansion 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.Clinical Question/Level Of EvidenceTherapeutic, IV.

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