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PubMed1991

[Rapid tissue expansion: value of the measurement of the transcutaneous oxygen pressure and intraprosthetic pressure].

Tissue expansion is often unpleasant for the patient because of its long duration. The authors present a series of 16 rapid expansion prostheses implanted in 10 patients. The expansion was monitored by measuring the percutaneous oxygen partial pressure and intraprosthetic pressure. The expansions were performed without any complications. Monitoring of the expansion by measuring the pcPO2 appears to ensure good results.

Adolescent↗
PubMed1984

Soft-tissue expansion: concepts and complications.

Soft-tissue expansion complements existing reconstructive techniques and provides new vistas for the plastic surgeon. The technique finds use for overcoming a shortage of tissue, for obtaining skin with special desirable qualities, for creation of flaps otherwise not possible because of the resultant donor site or limited vascularity, for creation of flaps with functioning muscle and overlying soft tissue, and for minimizing flap donor-site problems. Careful planning should include patient counseling, optimum incision placement, and time for a leisurely, complete expansion. The surgery can often be performed under local anesthesia and expansion is tolerated well. Patients should be counseled that the incidence of major complications in an unselected series is 1 in 4 patients. Major complications, however, typically result in a delay in reconstruction and not tissue loss.

Adult↗
PubMed1999

Complications of tissue expansion in a public hospital.

Avoidance of complications in tissue expansion requires careful outpatient observation and consistent follow-up-two factors that are difficult to manage in a city hospital-based population. To determine the complication rate of tissue expanders in a given population, the authors reviewed retrospectively 34 tissue expanders placed in 30 patients at a New York City public hospital over a 7-year period from 1989 to 1996. The mean age of the patients at the time of insertion was 25 years (range, 11 months-65 years). The most common conditions for treatment were nevi (N = 11), burn scars (N = 8), breast reconstructions (N = 8), and spina bifida (N = 4). Complications occurred in 22 of 34 expanders (65%). Complications included deep infection (N = 11), exposure (N = 7), breakdown of the surgical wound (N = 4), cellulitis (N = 3), drainage (N = 1), and deflation (N = 1). Major complications resulted in premature removal in 13 of 34 expanders (38%). Minor complications leading to successful completion of the expansion process occurred with 9 of 34 expanders (27%). No complications were recorded in the remaining 12 of 34 expanders (35%). Although tissue expansion is a potentially safe and effective method of reconstruction, this review should alert the surgeon to the distinct challenges that may be encountered in the public hospital.

Adolescent↗
PubMedDate not supplied

Soft tissue expansion in the management of the rare craniofacial clefts.

Management of the rare craniofacial clefts requires correction of both the soft tissue and skeletal hypoplasia. Tissue expansion of adjacent and distant soft tissue has been used to reconstruct these facial clefts with like quality tissue. Additionally, such soft tissue expansion permits tension free reconstruction of the skeletal clefts by osteotomy and bone graft.

Abnormalities, Multiple↗
PubMed1990

The use of tissue expansion for immediate breast reconstruction after mastectomy.

A series of 139 patients who had a total mastectomy underwent breast reconstruction using the method of tissue expansion. In 127 patients a tissue expander was inserted at the time of mastectomy and in 12 patients this was done as a delayed procedure. The reconstruction was successfully completed in 87% of cases and the patient acceptance of this method of reconstruction has been high. We believe that tissue expansion should be offered to all women having immediate reconstruction after total mastectomy and that it also has a significant role in delayed breast reconstruction after mastectomy.

Adult↗
PubMed2002

[Our experience with tissue expansion on a series of 50 cases in Vietnam].

The authors reviewed their experience with tissue expansion from July of 1995 to December of 1999 at Hanoi Plastic Surgery Center. A total of 75 tissue expanders of various sizes were placed in 50 consecutive patients (16 men and 34 women) for the reconstruction of secondary defects (burn scars, skin graft scars, hypertrophic scars, keloids, capillary hemangioma, congenital nevi and micotia). The average age of patients was 21 years. The tissue expansion protocol was used in clinical as well as common principle. The main technical details are modified in this procedure by the authors: type of intralesional incision for expander insertion, closing of wound incision by three layers, evacuation of the liquid in the prosthesis pocket, injection with antibiotic solution and expanded flap capsulectomy. The complications rate was 10.6% (8 complications in 75 expanders). The most common complications consisted of infection, hematoma, exposure of valve, dehiscence of incision, necrosis of the distal expanded flap. The overall failure rate was 8%. Thus our modified surgical details allowed us to decrease the major complications and to achieve the best possible functional and aesthetic results.

Adult↗
PubMed1992

Alterations in skin properties during rapid and slow tissue expansion for breast reconstruction.

This study comprises 23 women who had had mastectomies because of breast cancer. They were randomly divided into two groups when they were admitted for breast reconstruction by tissue expansion. The first group was expanded rapidly, i.e., every day, and the other group was expanded slowly, i.e., every week. There were no other differences in the treatment between the two groups. Three months after completion of expansion, the expander was replaced by a permanent prosthesis. The follow-up time was up to 6 months after the second operation. Three different parameters--distensibility, elasticity, and hysteresis--were measured noninvasively on the breast skin and at a control site on several occasions throughout the treatment. During the treatment period there were no differences in skin properties between rapidly and slowly expanded patients. Of the three parameters, distensibility showed the most prominent changes: decreasing during the expansion period, increasing after the expander had been replaced by a permanent prosthesis, and decreasing during the following 6 months. Elasticity did not change significantly, except decreasing after insertion of the permanent prosthesis, and the hysteresis increased at the same time. These findings indicate that tissue expansion alters breast skin only to a small extent and that the mechanical resistance sometimes encountered during tissue expansion is due to deeper structures such as underlying muscles or capsule formation.

Body Water↗
PubMed1993

Combined tissue expansion: clinical attempt to decrease pain and shorten placement time.

Tissue expansion can be characterized as a unique reconstructive procedure that takes advantage of the intrinsic ability of tissues to stretch and, in some instances, to grow in response to expansive forces. The efficacy of combined intraoperative expansion to obtain sufficient expanded tissue more rapidly was tested in reconstructions of the extremities, and the comparison between conventional and combined expansion was performed observing five parameters: initial injected volume, pain score, duration of pain, total period of expansion, and histologic findings. We treated 22 patients with conventional expansion and 29 with combined expansions. The latter approach enabled us to overexpand the expanders initially and was associated with lower pain scores than conventional expansion. Furthermore, in the combined expansion group, shortening of the duration of pain was statistically significant in the upper arm (p < 0.05) as well as in the lower leg (p < 0.01). In this group, the total expansion period also was significantly shorter (p < 0.01). Histologically, only minor differences were seen between groups. In this study, intraoperative expansion combined with subsequent rapid overinflated expansion proved to be superior to conventional expansion not only in reducing expansion time but also in decreasing pain. We consider the following effects to contribute to this result: (1) increased skin elasticity due to repeated intraoperative load cycling, which leads to easier expansion of the skin and less irritation of the sensory nerves, (2) improved survival and vascularization of skin flaps due to the "delayed-flap" phenomenon, and (3) prevention of shrinkage of the expanded skin and widening of scars due to overinflated expansion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1988

Tissue expansion for head and neck reconstruction.

Tissue expansion is a new reconstructive technique with enormous potential. Although popularized over 10 years ago, its place in the management of soft tissue reconstruction for head and neck malignancy is undefined. In this paper 3 clinical cases are illustrated.

Adolescent↗
PubMed1988

Complications of soft tissue expansion.

This paper presents a critical review of the results of tissue expansion in our clinical experience. Seventy-six expansions performed in 66 patients between 1981 and August 1986 are included in the study. Complications necessitating some revision in the original treatment plan were documented in 39% of cases. However, sufficient tissue was usually generated to complete the proposed reconstruction without compromising the final results. The complications of tissue expansion are further analysed in relation to their anatomical distribution, time of onset and ultimate consequences. Causative factors are identified and preventative measures are introduced.

Adolescent↗
PubMed1998

Light and electron microscopic evaluation of the pectoralis major muscle following tissue expansion for breast reconstruction.

The placement of tissue expanders under the pectoralis major muscle has become a common procedure in breast reconstruction after mastectomy. Little information is available regarding the changes caused by tissue expansion on human skeletal muscle. In this study, we report the light and electron microscopic changes observed in 20 expanded pectoralis major muscles from 12 patients undergoing two-stage breast reconstruction procedures. Standard 400-cc round Radovan tissue expanders were placed, eight bilaterally and four unilaterally. Three biopsies were taken from each muscle at different locations during both the first stage (pre-expansion) and 23 weeks later at the second stage (postexpansion). The operative procedures and expansion protocol were the same in all reconstructions. No postoperative radiation therapy was added. The histologic changes were reported in a blind fashion by one pathologist. Light microscopy did not show significant pathologic changes. All but one of the pre-expansion specimens examined by electron microscope were reported as normal, whereas all of the postexpansion biopsies were grossly altered. Focal muscle fiber degeneration with glycogen deposits and mild interstitial fibrosis was noted. In addition, some fibers showed disorganization of the myofilaments in the sarcomeres. The above ultrastructural changes are significant morphologic alterations, which may be the result of muscle hypoxia. Whether these changes indicate permanent or transient transformation is yet unclear. Patient follow-up did not reveal any functional muscular deficit. We conclude that there is definite evidence to suggest significant muscular structural damage after routine subpectoral expansion for breast reconstruction.

Adult↗
PubMedDate not supplied

[Tissue expansion in head and neck regions].

The Authors describe their experience with the use of 56 tissue expanders implanted in the head and neck regions of 45 patients observed in a follow-up of an average of 25 months. They emphasize the various possibilities of reconstructive surgery with the use of tissue expanders and the different mental approach required in order to organize surgical when this technique is employed. The criteria used in the selection of the type of tissue expanders is outlined and useful advice concerning the formulation of a surgical plan which employs the most favourable approach in making to avoid poor functional or aesthetic results or secondary complications is presented. Furthermore the surgical technique used to obtain adequate pockets for the insertion of tissue expanders in the different anatomical areas of the head and neck is described. The Authors affiem that in order to avoid damage to the surrounding neurovascular structures and to obtain good tissue expansion, the correct level of dissection is imperative. The options of using different anatomical areas during reconstructive surgery are discussed. For example, the insertion of a tissue expander in the forehead permits the availability of a large amount of usable tissue during nasal reconstruction, thus leaving the donor area without tension and with minimal scarring. Many different causes of baldness can be treated with the use of tissue expanders, such as posttraumatic injury, burns or infections. Tissue expansion can be utilized in the cheek area for the reconstruction of the lower eyelids, the paranasal and the mandibular area. Tissue expanders used in the cervical area can be utilized for reconstructive surgery of the lower lip or the mandibular area. In addition, the Authors discuss possible complications of this technique such as infection, suture distension and tissue expander extrusion. Recommendations are discussed in order to prevent these major complications. Having reviewed their personal experience the Authors feel they can confirm the reliability of this revolutionary technique in the field of plastic and reconstructive surgery. The use of tissue expanders permits the surgeon to obtain improved functional and aesthetic results which only a few years ago were not conceivable.

Female↗
PubMed1996

[Tissue expansion. Presentation of a model of external filling valve].

Based on their experience of facial tissue expansion, the authors present a model of an external filling valve and illustrate its advantages in 9 cases in which 13 external valve were used: painful injection, absence of leakage, fast and confortable filling. The indications are sequelae of facial burns, face scars, treatment of orbito-temporal neurofibromatosis. The major advantage is rapid tissue expansion which reduces the problems of infection and skin loss.

Face↗
PubMed2001

Serial tissue expansion for reconstruction of burns of the head and neck.

There is little reported on serial tissue expansion for reconstruction of burns of the head and neck. Fourteen children (mean age 7.8 years, range 3-11 years) treated over almost an 11 year period, had a total of 67 expanders used. Fourteen children had expansion performed on the first occasion, 14 again on a second occasion, 10 on a third occasion and one on a fourth occasion. The major complication rate (expander extruded prior to completion of the expansion process) was 21,25 and 14%, respectively. In all cases, the burn scar was completely excised or reduced in size. Serial tissue expansion should be considered as a useful method of reconstruction burns of the head and neck.

Africa↗
PubMed1989

The use of tissue expansion in lower extremity wounds in paraplegic patients.

A report of the use of tissue expansion in the lower extremity of paraplegic patients is presented with over 1-year follow-up in two cases. Expansion was accomplished without difficulty and without compromise of skin integrity when performed carefully and slowly. It is important to observe the overlying skin for capillary refill. Pain, which may limit expansion in neurologically intact patients, is not a factor in paraplegics. By using tissue expansion, more risky, longer procedures using myocutaneous flaps or microvascular tissue transfers may be unnecessary, and reliable, durable, full-thickness coverage is obtained in two short procedures.

Adult↗
PubMed1995

Acne keloidalis nuchae. Tissue expansion treatment.

BACKGROUND: Acne keloidalis nuchae (AKN) is a chronic idiopathic reaction responsible for a great deal of discomfort in patients, and requires radical treatment to be eradicated. OBJECTIVE: To analyze the technique used for and the results of a case of AKN treated with tissue expansion, which was tracked for 2 years after the initial study. METHODS: A patient with AKN was treated with chronic tissue expansion, total resection, and reconstruction of the injured area by advancing the flap of the expanded scalp. Local radiotherapy was applied to the resultant scar. RESULTS: After 2 years' follow-up we did not observe a recurrence of AKN, and a good cosmetic result was achieved. CONCLUSION: Tissue expansion has a role in surgical management of AKN. Staged excision, skin grafting, and nonsurgical treatments are also options, however they must be individualized to the case at hand.

Acne Keloid↗
PubMed1998

The effects of soft-tissue expansion on lip repair and midfacial growth in a rabbit cleft lip model.

Midfacial hypoplasia following primary cleft lip repair is a common clinical correlate. Recent experimental work has suggested that increased lip pressure following an undermined lip repair may contribute to midfacial growth inhibition. Soft-tissue expansion has been used to generate additional soft tissue for reconstruction in the cranial region. The use of this technique in the labial region may allow lip repair to be performed with less tension (pressure) and thus facilitate midfacial growth. To test this hypothesis, 40 4-week-old rabbits were randomly divided into four groups. Two groups had surgically created lip and alveolar defects. Ipsilateral labial tissue expanders were placed in all four groups. One cleft and one normal group underwent expansion. The other two groups served as a control. The expanders were removed at 4 weeks, and an undermined lip repair was performed in both cleft groups. Findings revealed that soft-tissue expansion increased labial surface area significantly by approximately 96% (p < 0.001). Labial soft-tissue expansion alone had no effect on midfacial growth during the observation period. In contrast, cleft animals undergoing tissue expansion exhibited significantly reduced (p < 0.05) postoperative lip pressure and increased midfacial growth compared with cleft animals without expansion through 36 weeks of age. Results suggest that preoperative tissue expansion reduced postoperative lip pressure and improved midfacial growth in a rabbit cleft lip model.

Animals↗
PubMed1986

Objective monitoring for safe tissue expansion.

The high incidence of complications during tissue expansion may be related to overexpansion with subsequent tissue necrosis and implant extrusion. Subjective parameters such as pain or capillary fill may be poor guidelines for determining the end point of a given session of expansion. In an attempt to rectify this problem, we have shown in a prospective study of eight consecutive patients that noninvasive objective monitoring utilizing transcutaneous measured oxygen levels, local perfusion, and implant pressures allowed us to quickly and safely expand each patient. Although perhaps cumbersome for routine use, this system proved valuable in complicated situations where subjective parameters could not be observed.

Adolescent↗