Rethinking tissue expansion: beyond skin expansion toward a reconstructive philosophy - a narrative review

Tissue expansion has traditionally been regarded as a technique for generating additional skin. Beyond its established technical applications, however, its broader conceptual role in reconstructive surgery has received comparatively little attention. This narrative conceptual review reexamines tissue expansion from the perspective of reconstructive thinking rather than operative technique. We discuss the biological basis of tissue adaptation, the evolution of tissue expansion within modern reconstructive surgery, and its integration with contemporary reconstructive strategies, including local, regional, perforator, and free flaps. We propose that tissue expansion can be understood as a reconstructive philosophy in which biological tissue generation, anatomical fidelity, and preservation of regional identity guide reconstructive decision-making.