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Results for “Tissue Expansion”

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At least 217 records · Page 12Linked to original sources
PubMed1990

Pretransfer tissue expansion of a scalp free flap for burn alopecia reconstruction in a child: a case report.

A nine-year-old boy who sustained severe grease-fire burns over his right scalp, face, neck, and trunk 14 months previously, presented with extensive alopecia over the right frontotemporoparietal scalp. Near complete coverage of the scalp defect was obtained with pretransfer expansion of the left temporoparietal scalp, followed by free-flap transfer of the expanded tissue to the defect. Pretransfer tissue expansion has the advantages of increasing flap surface area and minimizing donor site deformity. This case illustrates the applicability of pretransfer tissue expansion of free flaps, and demonstrates the excellent results achievable with free-flap scalp transfers.

Alopecia↗
PubMed1988

Dermal and epidermal response to soft-tissue expansion in the pig.

To evaluate the dermal and epidermal response to soft-tissue expansion in the pig, round tissue expanders were placed dorsally under tattooed patterns and inflated over 6 weeks. Surface area, skin thickness, histologic changes, and collagen content were evaluated at 6-week intervals. Epidermal thickening and dermal thinning were observed. Dermal thinning persisted 36 weeks after expansion. Dermal collagen content was decreased, although collagen density remained unchanged. Total collagen content calculated within an expanded square grid increased. These data support a theoretical gain in the dermal layer as well as epidermal layer in response to tissue expansion.

Animals↗
PubMed1992

[Experimental studies on tissue expansion in reconstructive surgery].

In the present study, a porcine model for controlled tissue expansion was investigated under the conditions or formation of extreme enlarged randomized flaps. The circulatory disturbances and necrotizing processes to be expected were evaluated immediately after flap formation by intravenous injection of fluorescein dye to predict the surviving area. Lectin histochemistry and immunohistology were performed using either the direct and indirect immunofluorescence technique (DIFT, IIFT) or immunoperoxidase techniques (POX). Over all, the expanded randomized flaps healed without complications in all animals. The acute randomized flaps showed clear necroses already after 10 days. In the thoracic area they averaged 60.3% (SD = 8.17%) and in the pelvic area 47.32% (SD = 14.11%) of the flap. The use of the fluorescein dye test in the present experiment demonstrated that the flap surviving area is significantly greater than the flap staining area. The regular expression of suprabasal keratins and epidermal lectin binding sites provides evidence for a normal epidermal cell differentiation.

Animals↗
PubMed1996

Effects of intraoperative tissue expansion and skin flaps on wound closing tensions.

OBJECTIVE: To evaluate the effect on wound closing tension of acute tissue expansion combined with development of a rectangular flap compared with simple undermining with rectangular flap development. DESIGN: Wound closing tensions of 30 acutely expanded skin sites and 30 matched undermined sites were compared after development of rectangular flaps. Analysis of covariance was used to determine statistical significance. SUBJECTS: Ten domestic piglets. RESULTS: When mean values of wound closing tension for the expanded rectangular flap were compared with those of the undermined rectangular flap a significant difference was found at the intermediate points along the curve for tension vs length of skin stretch. CONCLUSION: For small lesions, acute tissue expansion in conjunction with the use of a rectangular flap results in decreased wound closing tensions when compared with simple undermining with the use of a flap.

Animals↗
PubMed2003

[Labia minora skin flap vaginoplasty using tissue expansion].

OBJECTIVE: This is to introduce a method for vagina reconstruction using the expanded labia minora flap. METHODS: Two tissue expanders were implanted in the labia minora bilaterally and expanded slowly over 4 weeks. In the operation, the expanded labial tissue was advanced as a bipedicle flap to line the reconstructed vagina. Five patients were treated with this method. Postoperative stent placement and dilation resulted in a vaginal canal exceeding 8 cm in depth. RESULTS: During the follow-up of 6 months to 2 years, four of the five patients got married. The vulva exhibited almost indistinguishable appearance. The reconstructed vagina had sensory and secretary functions. Its morphology and depth well meet the physiological demand. CONCLUSIONS: The modified method of tissue expansion vaginoplasty using the labia minora bipedicle flap is a good option for vagina surgery. The reconstructed vagina possesses the anatomical and physiological resemblance.

Female↗
PubMed1996

Intraorbital tissue expansion in the management of congenital anophthalmos.

Seven cases of intraorbital tissue expansion for the treatment of congenital anophthalmos or microphthalmos are presented. The ages of the patients at insertion of the expander ranged from 4 months to 8 years. A 4 ml spherical tissue expander with a remote injection port was inserted into the affected orbit via a bicoronal approach. Expansion periods ranged between 4 months and 3 years and are continuing in 2 patients. Results were assessed by clinical examination, comparison of photographs, 3D CT scans and orbital measurements taken from axial CT scans which were compared with established normal values. Results confirmed enlargement of the orbit with expansion. Long-term expansion over several years established near normal bony growth patterns. Placement of the expander within the orbital soft tissue cone resulted in more symmetrical expansion than subperiosteal placement. An osteotomy releasing the lateral orbital wall in older children allows expansion of the orbit and may reduce the incidence of expander extrusion. Although intraorbital tissue expansion successfully induces orbital growth, improvement in the form and size of the congenitally deficient eyelids is less marked.

Anophthalmos↗
PubMed1991

Tissue expansion in functional and aesthetic reconstruction of the trunk and extremities. Case report.

To illustrate how the technique of tissue expansion may be adapted for different types of reconstruction, the following cases are described: a 10-year-old girl with a circumferential naevus from shoulder (at the back) and umbilicus (at the front) to the knees; a 3-year-old boy with a severe injury to the left arm; a 36-year-old man with an amputation injury of the left hip; and an 18-year-old girl with scars from a complicated fracture of the left lower leg. In all cases function and/or appearance were considerably improved.

Adolescent↗
PubMed2002

[Experimental study on enhancement of tissue expansion with papaverine cream].

OBJECTIVE: To evaluate the effect of external use of papaverine cream on enhancement of tissue expansion. METHODS: 8 mini pigs were randomly divided into 4 groups. During inflation, papaverine was given externally in group A, through a delivery system in group B, though intramuscular injection in group C. Papaverine was not given in group D. The time of inflation, the expansion rate, the surviving length of expanded flaps and the papaverine concentration in the fibrous capsule in each group were examined. Histologic and electroscope examinations of the expanded tissue were made. RESULTS: The average inflation time was 28.9 +/- 4.5 days in group A, 34.0 +/- 2.6 days in group B, 37.6 +/- 4.8 days in group C and 38.5 +/- 3.5 days in group D. There was significant difference between each group(P < 0.05). The average surviving length of expanded flaps in group A was 13.67 +/- 1.28 cm, 11.07 +/- 0.88 cm in group B, 10.79 +/- 0.49 cm in group C, and 9.49 +/- 0.77 cm in group D. There was significant difference between each group (P < 0.01). Histologic examinations of the expanded tissue suggested that there were no significant differences in thickness of epidermis, derma and fibrous capsule among the four groups. Electroscope examinations of the myofibroblast in fibrous capsule showed that there were smaller nuclei, fewer microfilaments and fewer mitochondrias and rougher endoplastic reticulume in group A than those in other groups. The concentration of papaverine in fibrous capsule of group A was 3.5 +/- 1.2 micrograms/g. Papaverine was detected neither in the skin of other groups nor in the blood of all groups. CONCLUSIONS: 1. Papaverine cream can permeate through skin and maintain high concentration and continuous effect in local tissue. 2. External use of papaverine cream can inhabit the function of myofibroblast in fibrous capsule, increase inflation rate, accelerate expansion process, and improve microcirculation of the expanded skin with a result of prolongation of surviving length of expanded flaps. 3. The technique of enhancing tissue expansion with external use of papaverine has the advantages of convenient delivery, cheapness, no more injury and infection, and no side effects etc. It is a safe, effective, simple, and reliable method for accelerating tissue expansion.

Animals↗
PubMed1998

Vascular endothelial growth factor expression in expanded tissue: a possible mechanism of angiogenesis in tissue expansion.

Vascular endothelial growth factor (VEGF) is a major angiogenic growth factor. Angiogenesis stimulated by VEGF occurs in several important clinical contexts, including myocardial ischemia, retinal disease, and tumor growth. The level of VEGF is increased in several skin disorders and is stimulated by ischemia. Tissue expansion has been shown to induce angiogenesis and ischemia on the overlying skin. We therefore investigated the hypothesis that VEGF was expressed in expanded tissue. Three samples of skin were obtained from five patients who sustained reconstruction with tissue expansion. One sample was taken on the implantation site of the expander before implantation. Two samples were taken at the time of removal, respectively, one on the nonexpanded skin adjacent to the expanded area and one on the expanded skin on the site of expansion. On these samples we performed immunolocalization of VEGF. Mouse monoclonal antibody was used, recognized with rabbit anti-mouse immunoglobulin alkaline phosphatase-anti-alkaline phosphatase (APAAP) complex conjugated and revealed with naphthol red. Our results showed clearly an increased number of cells that fixated VEGF antibody on the site of expansion. Cell counts revealed that the numbers of cells expressing VEGF were statistically higher in expanded tissue than in nonexpanded tissue. Before expansion skin specimens did not express VEGF. These findings are the first to show the presence of a growth factor in expanded tissue. They open a new field of research on the biological explanation of tissue-expanded angiogenesis.

Antibodies, Monoclonal↗
PubMed1998

Wound coverage using modified tissue expansion.

We describe the use of a "lacing apparatus" across large and complex wounds to accomplish wound closure. This technique utilizes the principles of tissue expansion (exploiting inherent extensibility of the skin, mechanical creep, and biologic creep) but is able to employ them in situations in which traditional tissue expansion (utilizing implantable expanders) is not practical. After preparation, the wounds are laced with large nylon suture, which is tightened on a daily basis, typically allowing closure of even massive wounds within 8 to 10 days. In this report, we describe the technical details of wound preparation, application of the lacing apparatus, and postoperative execution of the expansion leading to final wound closure. This technique is particularly valuable in the upper arm, trunk, and lower extremity but has limited application in the distal forearm and the distal third of the lower extremity.

Adult↗
PubMed1989

Failed tissue expansion in a patient with osteogenesis imperfecta.

This is a report of a failure of tissue expansion in a 43-year-old patient suffering from a mild form of osteogenesis imperfecta tarda. Filling of the expander was not possible. Skin histology showed thrombosis of the blood vessels and vessel wall necrosis. This finding supports the theory that tissue expansion does not depend as much on mechanical skin laxity as on the proliferative potential of the skin.

Adult↗
PubMed1998

Molecular basis for tissue expansion: clinical implications for the surgeon.

A wide variety of tissue expansion techniques have been used for breast reconstruction, craniofacial surgery, and burn care in plastic reconstructive surgery. However, the basic mechanism by which skin and surrounding tissue respond to mechanical expansion remains unclear. Recent studies have revealed the biomechanical aspects of cells subjected to strain and various factors involved in the stretch-induced signal transduction pathway. In this regard, we have reported previously that mechanical force increases keratinocyte growth and protein synthesis and alters cell morphology. The mechanism by which strain causes an enhancement of cellular growth appears to be a network of several integrated cascades, implicating growth factors, cytoskeleton, and the protein kinase family. Recently, additional evidence has accumulated that mechanical strain stimulates signal transduction pathways that could trigger a series of cascades eventually leading to a new skin production. For example, we have evidence suggesting a key role for protein kinase C (PKC) in mechanosignaling as PKC is activated and translocated in keratinocytes subjected to strain in an isoform-specific manner. In this report, molecular mechanisms leading to enhancement of skin surface area are reviewed, and possible future applications are discussed.

Burns↗
PubMed1991

Applications and complications of tissue expansion in pediatric patients.

We have reviewed our experience with 61 tissue expansions in 49 pediatric patients. Indications for expansion included traumatic alopecia or soft tissue loss, myelomeningocele, congenital hairy nevi, burn scars, and other less common defects. The complication rate, necessitating interruption of expansion, was 25%. This occurred more frequently with scalp and burn reconstruction. Nevertheless, 86% of patients ultimately achieved good to excellent results.

Adolescent↗
PubMed2005

[Breast reconstruction after prolonged tissue expansion. About 247 cases].

SUBJECT: The purpose of this study was to analyse the complications and the aesthetic results in case of slow tissue expansion in prosthetic breast reconstruction. PATIENTS AND METHODS: We tracked 237 patients representing 247 mammary reconstructions operated between 1992 and 2004. These patients were distributed in two series, a series of 148 operated mammary reconstructions between 1992 and 2000 and a series of 99 reconstructions operated between 2001 and 2004. For every reconstruction, we analysed the progress of the expansion, the complications and the quality of the aesthetic results according to the radiotherapy and the type of implant used. RESULTS: The radiotherapy increases the risk of failure of the breast reconstruction and degrades the quality of the aesthetic results. Capsular contractures are rare and their frequency does not depend on the irradiation. Prosthesis infections and exposure are more frequent on irradiated ground. DISCUSSION: The tissue expansion in prosthetic breast reconstruction is a technique studied well in the literature, but few authors use a chronic expansion and compare the long-term results according to the radiotherapy. If our study confirms the noxious role of the radiotherapy as for the complications and for the aesthetic aspect of the results, it is not a question for us of an absolute contraindication. The weak rate of capsular contracture is attributable to the chronic character of the expansion, which allows the maturation of the capsule. The use of silicone gel implants decreases the deflations but does not improve the results. CONCLUSIONS: The radiotherapy increases the risks of failure of the tissulaire expansion and decreases the quality of the aesthetic results. The chronic character of the expansion allows to obtain a rate of capsular contracture weak, even on irradiated ground. The silicone gel implants make it possible to obtain a perennial result.

Adult↗
PubMed1991

Tissue expansion in reconstruction of postburn contracture of the first web space of the hand.

The successful release of severe contracture of the first web space depends on addition of a sufficient amount of skin. Because local skin is limited, skin grafts tend to contract, and free and pedicle flaps are bulky, further procedures are often obligatory. Expansion of the tissues of the dorsum of the hand offers an effective and relatively simple approach to generate the excess skin needed. We present a patient in whom an inflatable silicone implant was used to correct recurrent first web space contracture after burns.

Adolescent↗
PubMed2000

[Ehancement of tissue expansion in guinea pig by local delivery of chemical agents using a new type expander].

OBJECTIVE: To search for the new method to increase the rate of tissue expansion. METHODS: A new type of double-lumen expander was buried in the back of guinea pig. Through the expander chemical agents (papaverine) were delivered. RESULTS: The new expander could effectively deliver chemical agents. In comparison with the control group, the blood flow, survival length and the length to width ratio of the expanded flap in the experimental group increased statistically. The immediate retraction ratio of the flap decreased significantly. The epidermis was thicker while the dermis was not significant different from the control. The panniculus carnosus was significant thinner in the expanded group than the unexpanded group. The deep connective tissue was statistically thinner in the group using the new type expander. CONCLUSION: The new type of expansion method could accelerate tissue expansion rate and improve the quality of expanded skin and flap.

Animals↗
PubMed1992

Intraluminal lidocaine for analgesia after tissue expansion: a double-blind prospective trial in breast reconstruction.

A double-blind prospective placebo controlled trial of intraluminal lidocaine for pain relief after tissue expansion was performed in 18 women undergoing breast reconstruction. In contrast to others' claims of effective analgesia, no difference in the incidence of immediate or late pain after expansion could be demonstrated between 100 mg of lidocaine and placebo. The overall incidence of early pain was 8%. This was significantly less frequent than late pain, which occurred after 36% of all expansions. Postexpansion pain (early or late) was reported after nearly one-half of all expansions, most of which was ascribed to late pain. The incidence of pain did not significantly depend on the temporal progression of breast expansion, nor was there a difference in the incidence and prevalence of pain for patients undergoing unilateral versus simultaneous bilateral expansion.

Analgesia↗