• Gan-lin Zhang, Jin-ming Zhang, Chen-yang Ji, Hong Meng, Jian-hua Huang, He-yuan Luo, Hua-sheng Zhang, Xiao-tao Liu, and Xiao-fang Hong.
• Aesthetic Plast Surg. 2013 Dec 1; 37 (6): 1202-8.

BackgroundThis study aimed to compare the difference between the skin expansion and contraction rates for an expanded flap with one versus two expanders.MethodsThe study cohort comprised 24 cases of two overlapping expanders and 15 cases of a single implanted expander involving 22 patients. The method of "wet-cloth sampling" was applied to measure the expanded flap area and the initial unexpanded area and to calculate the skin expansion rate. Two points 5 cm apart in the center of the expanded flap were selected before the second surgical stage. After removal of the expander, the distance between the two fixed points was measured and recorded. The contraction rate of the expanded flap then was calculated.ResultsDuring the same period of expansion in the two groups (p = 0.06, >0.01), the skin expansion rate was 3.5 ± 0.9 % in the group with two overlapping expanders and 2.6 ± 0.6 % in the control group. The difference between the two groups was statistically significant (p = 0.002, <0.05). The instantly expanded flap contraction rates were 30.3 ± 0.8 and 32.3 ± 0.9 %, respectively for the two groups, and the difference was not statistically significant (p = 0.47, >0.05). We fitted a linear regression model that was Y = 0.533 − 0.003X, where Y was the contraction rate of the expanded flap and X was the period of expansion. The contraction rate of the expanded flap was negatively correlated with the period of expansion.ConclusionsCompared with the traditional method of implanting a single expander, the new method of overlapping two expanders in a single cavity increased the skin expansion rate. The instantly expanded flap contraction rate did not differ significantly between the two groups, so the amount of expanded skin area absolutely increased. The clinical application of the new method is worth promoting.Level Of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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