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PubMed2001

Tissue expansion for repair of severely complicated Achilles tendon ruptures.

We report on two patients with severely complicated Achilles tendon ruptures (ATR), including re-rupture, postoperative deep infection and subsequent tissue loss. Tissue expansion was used to facilitate tendon reconstruction and to ensure good healing potential with skin closure without tension. Tissue expansion is a valid option in patients with complicated ATR. The outcome for the two patients described here was good, with improved function and no major complications.

Achilles Tendon↗
PubMed1989

The effect of tissue expansion on peripheral nerves.

The effect of tissue expansion on peripheral nerves was studied in 214 rats. Slow expansion (over 15 days) is better tolerated than rapid expansion (over 3 days). The resulting increase in length of the nerve is proportional to the degree of expansion. All the nerves which underwent expansion showed a decrease in conduction velocity and this reduction was greater for nerves which were elongated by 50% or more.

Animals↗
PubMed1987

Chest-wall deformity following soft-tissue expansion for breast reconstruction.

We have presented a case in which the presumed pressure effects of tissue expansion caused multiple nondisplaced rib fractures of the anterior thorax in a patient undergoing breast reconstruction. Although the deformity was severe, a satisfactory cosmetic result was obtained and there have been no clinically significant sequelae during a 1-year follow-up period. The degree of bony deformation was most likely enhanced by the combination of this patient's severe osteoporosis, chronic steroid use, and peripheral vascular disease. The fragility and ease of fracture in the bones of osteoporotic postmenopausal females and the long-term effects of steroids on tissues is well known. We believe this observation to be important, since many reconstructed patients are postmenopausal and have variable degrees of osteoporosis. Many undergo adjuvant chemotherapy with steroids and antihormonal agents, and this group of women may therefore be at a greater risk for the occurrence of pressure deformities. The incidence and long-term significance of such deformities are not known. The reconstructive surgeon should be alert to the possibility of this phenomenon occurring as a result of tissue expansion in the patient with severe osteoporosis, peripheral vascular disease, or chronic steroid use.

Breast↗
PubMed1999

Secondary reconstruction of a giant congenital lentiginous dermal nevus with serial, large-volume tissue expansion.

Giant congenital pigmented nevi pose a substantial reconstructive challenge for the treating physician. Due to the increased risk of malignant transformation in such lesions, complete excision with tissue expansion or skin grafting is the generally accepted treatment. These modalities can, however, leave the patient with secondary deformities that also require complex reconstructive procedures. The following case details a patient requiring secondary reconstruction with large-volume tissue expansion 12 years after excision of a giant nevus, and split-thickness skin grafting. This patient illustrates a severe secondary deformity and the usefulness of large-volume serial expansion in such patients.

Child↗
PubMed1999

[The clinical application of triamcinolone to accelerate soft tissue expansion].

OBJECTIVE: To speed up the expansion procedure. METHODS: Triamcinolone was injected during tissue expansion in 26 cases. RESULTS: The study proved that triamcinolone shortened the injection interval to 32 +/- 6 hours. The mean time of full expansion was shortened to 20 +/- 5 days in the experimental group. The injection interval and mean time of full expansion were 6 +/- 2 days and 42 +/- 8 days respectively in the control group (P < 0.01). The immediate retraction ratios of expanded skin of the two groups were 17% and 26% respectively. CONCLUSION: This new method is feasible in clinical application.

Adolescent↗
PubMed1997

Aesthetic results and patient satisfaction with immediate breast reconstruction using tissue expansion: a follow-up study.

Immediate breast reconstruction with the tissue expander is now established as an accepted procedure after mastectomy, and large series have been published concerning the technique and its complications. Unfortunately, only scarce information is available regarding the long-term aesthetic results and patient satisfaction achieved by immediate reconstruction using tissue expansion. In this study, we reviewed 52 patients who had undergone immediate breast reconstruction using the tissue expander with a follow-up of at least 1 year after completion of the reconstruction. We developed an objective assessment of patient satisfaction, aesthetic results, and the factors affecting them. The results show remarkable concordance of assessment by patient, surgeon, and independent observer: All gave good scores for aesthetic appearance (6.4 to 7.4 on a scale of 1 to 10). A total of 92.3 percent of patients rated their satisfaction as good to excellent. Symmetry was the main parameter influencing the patients' score, while the surgeon's score also was affected by the quality of the inframammary fold and capsular contracture. Breast size, chemotherapy, complications, time interval, and additional procedures had no relation to either scoring or patient satisfaction.

Breast Neoplasms↗
PubMed1992

Analysis of risks and aesthetics in a consecutive series of tissue expansion breast reconstructions.

A consecutive series of 73 patients underwent tissue expansion for breast reconstruction between 1980 and 1986. The cases were reviewed, and preoperative risk factors, postoperative complications, and aesthetic results were assessed. Cigarette smoking correlated with a higher incidence of complications and unfavorable results. Similar correlations were found among patients with histories of significant medical disorders or alcohol abuse, although patient numbers were small in these categories. Subpectoral and suprapectoral placement of expanders yielded similar complication rates and aesthetic results. Surgical techniques contributing to improved aesthetic results are described.

Adult↗
PubMed1990

Tissue expansion in the lower limbs of children and young adults.

We report the successful use of tissue expansion in the lower limbs of five children and one young adult. It was possible to replace dense adherent skin grafts by expanded skin and subcutaneous tissue. Such expansion needs to be undertaken slowly, but expanded tissue matches the normal local tissue and has normal sensation. These qualities were particularly important in three amputations which were revised.

Adolescent↗
PubMed1986

Tissue expansion: its role in traumatic below-knee amputations.

A case of nonhealing ulcer overlying a traumatic below-knee amputation treated with tissue expansion, excision, and primary closure is presented. Histologic evidence of tissue injury following tissue expansion is presented, and a recommendation for its cautious use in patients with impaired wound healing is suggested.

Adult↗
PubMed1996

Chest wall deformity following maximal tissue expansion for breast reconstruction.

Forty-three women, in a series of 150, participated in a prospective study that examined their chest walls for deformities 3 months after maximal tissue expansion for single-breast reconstruction. Computed tomography imaging was used for this purpose. Twenty-one patients underwent immediate breast reconstruction and the other 22 patients underwent delayed reconstruction. Fifty-three percent had some chest wall abnormality. In the delayed group, chest wall deformities were more statistically significant (p < 0.001). Our findings suggest that chest wall deformity is a common occurrence after maximal tissue expansion for breast reconstruction.

Adult↗
PubMedDate not supplied

The role of tissue expansion in the reconstruction of secondary burn defects.

Tissue expansion has become firmly established as an acceptable and useful modality in the treatment of various soft tissue defects. This article relates our experience with this technique for the reconstruction of secondary burn deformities in 26 patients. Details of expander placement and use are discussed, as well as the results and complications in this series. The advantages of this method, including a superior quality reconstruction, limited donor site morbidity, and cost-effectiveness, are discussed. The disadvantages of several operative steps, multiple office visits, and the objectionable appearance during expansion are enumerated. Guidelines for patient selection and technique refinements are also considered to reduce complications and to achieve an optimal functional and aesthetic result.

Adult↗
PubMed1996

Breast reconstruction and tissue expansion in irradiated versus not irradiated women after mastectomy.

Thirty-five women whose breast cancer had been treated by radiation and 111 in whom it had not underwent unilateral breast reconstruction with the tissue expansion technique after modified radical mastectomy. Their records were reviewed and in a questionnaire the patients reported their own opinion on the results. The two groups differed significantly, because those patients who had been irradiated had a more painful course of expansion and a less over-expansion. Their reconstructed breasts were harder, had more deformities, and they required significantly more capsulotomies. The irradiated group also reported less satisfaction with the cosmetic results and more unfulfilled expectations. Tissue expansion cannot therefore be recommended as a routine procedure for breast reconstruction in patients after irradiation. However, our results do not show whether other methods are better for these patients.

Adult↗
PubMed2001

Tissue expansion and serial excision in scar revision.

Scars in the head and neck caused by trauma or extirpative surgery can present a significant problem to the patient and may require revision. A variety of techniques, both surgical and nonsurgical, exists for treatment of unsightly scars. Surgical excision of scars relies upon recruitment of local tissue for closure of the ensuing defect. Tissue expansion and serial scar excision may be used to provide more tissue for advancement or local flap coverage of revised scars. Herein we review the history, technique, and complications of tissue expansion and serial excision as well as the basic scientific principles underlying these techniques.

Cicatrix↗
PubMed2000

Quantitative benefits provided by acute tissue expansion: a biomechanical study in human cadavers.

The aim of this study was to test the ex vivo biomechanical properties of acutely expanded cutaneous flaps to quantitatively assess the efficacy of intraoperative tissue expansion. A total of 14 fresh male cadavers were used for the study. In each cadaver, a rectangular (15 x 8 cm), proximally based flap was designed on each side of the body, in three different locations: lateral arm, anterior thorax, anterior thigh. In each cadaver, one randomly selected flap per each body region underwent acute-intermittent expansion, whereas the contralateral flap served as control. The biomechanical properties (stress/strain ratio, mean stiffness) of both expanded and control flaps were then assessed by means of a dynamometer and a force-transducer. The obtained data showed that the biomechanical benefits provided by acute tissue expansion were statistically different (P< 0.05) from those obtained by simple subcutaneous undermining. While no changes of length have been observed in the acutely expanded skin flaps as compared to control cutaneous flaps, a statistically significant gain in the compliance of the former has been recorded as compared to the biomechanical behaviour of the latter.

Adult↗
PubMed2000

Immediate breast reconstruction in two stages using anatomical tissue expansion.

Over the last four years, 43 modified radical mastectomies and 13 simple mastectomies were done for 56 patients with breast cancer followed by immediate reconstruction in two stages using anatomical tissue expansion. In 49 patients a permanent prosthesis was successfully implanted while three patients refused a further operation, and four required removal of the expander. Complications were seen in 21 cases, including infection (n = 4), Baker III-IV contractures (n = 5), radiodermitis with breast distorsion (n = 3), and seroma (n = 2). Four patients required removal of the expander, and no further attempts were made to reconstruct the breast. All 10 patients given radiotherapy developed some kind of complication. After a mean follow up of 2.5 years (range 6-48 months), the aesthetic result was rated 6.9 and patient satisfaction 7.8 on a 0-10 scale. We concluded that immediate breast reconstruction with anatomical tissue expansion gives predictable aesthetic results, which satisfied most patients. Although the complication rate is high, it does not exceed complication rates associated with mastectomy alone or delayed reconstruction. At present, only patients undergoing preoperative or postoperative radiotherapy and hesitant patients are not considered to be candidates for this procedure.

Breast Implantation↗
PubMed1994

A comparison of nerve grafting and tissue expansion techniques in the rat.

This study compares nerve repair following tissue expansion with nerve repair using an interposed graft in the rat. Group I had expansion conducted over 2 weeks at 40 mmHg. A 4 mm segment was excised from the lengthened nerve and repaired primarily. Group II had a 4 mm segment of nerve excised and then replaced as an interposition graft. Group III was sham-operated controls. Thirteen weeks postoperatively, all animals were evaluated using walking track analysis. Thirty-five rats finished the study: Eleven in group I, 10 in group II, and 14 in group III. The Sciatic Functional Index (SFI) was calculated for each group as follows: group I, -57 +/- 11 (mean +/- standard deviation); group II, -59 +/- 25; group III, -13 +/- 6.5. The control group was significantly better than either experimental group (P < 0.01). The two experimental groups were not statistically different. Nerve repair following expansion allowed only one coaptation to be used. Functional results were the same as with interposition grafting. Repair by the expansion technique would eliminate the need to harvest a nerve graft, and the subsequent donor defect.

Animals↗
PubMed1989

[Rapid tissue expansion].

The authors, who already have a wide experience of classical tissue expansion with slow inflation of prostheses over about 8 weeks, now present their experience of very rapid, virtually intraoperative expansion for the treatment of large scars and moderately large cicatricial zones. The operative technique which they use is described and the postoperative results are analysed.

Cicatrix↗
PubMed1994

Tissue expansion in median facial cleft reconstruction: a case report.

Median cleft of the face is a rare congenital anomaly. Patients with mild deformities require only limited nasal reconstruction; however, the nasal dorsal soft tissue envelope is usually tight and insufficient, making bone grafting difficult. The tissue-expansion method was used for nasal reconstruction in a patient with a median facial cleft, an expander being improvised from an intubation tube balloon.

Adult↗