Answer:
Skin can be stretched by other methods. The two referenced articles both come from Paris from the same group. One alternative to tissue expansion for lesions on the back in children involves concentric mobilization. The principle behind this is that the surface area of the entire back can theoretically be covered by mobilizing concentrically around the back. The other alternative for lesions across a joint is excision using enforced positions. For instance a lesion across the antecubital crease would be excised with the arm in forced flexion by splinting. The splinting is gradually changed to allow increased mobility at the joint over a period of weeks. This stretches the skin gradually and according to the authors' series does not result in any permanent joint limitation. Finally, the sure-closure system consists of two surgical stainless needles connected by a threaded tension bar. The device is applied across the edges of a wound and tension is applied to approximate the edges. It has limited usage but may be useful for fasciotomy wounds.