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PubMed1988

Accelerated tissue expansion with the "overfilling" technique.

Temporary overexpansion of the tissues at each filling session increased the actual inflation volume by about 59 percent. This shortened the process of tissue expansion considerably. "Overexpansion" means that the pressure in the expander is increased to a point where the dermal capillary flow is zero or the patient experiences so much discomfort that inflation cannot be carried out any further. The pressure in the expander is thereafter gradually decreased by taking out saline until both the capillary refill and all other clinical criteria are sufficient for safe dermal circulation. Comparison of the expander volume at the final pressure to the initial filling volume at the same pressure before the "overfilling" confirmed an average gain of about 59 percent in 14 patients.

Blood Volume↗
PubMed2003

Intraoperative acute tissue expansion revisited: a valuable tool for challenging skin defects.

BACKGROUND: The efficacy of acute tissue expansion (ATE) in achieving skin closure has been strongly debated. Proponents maintain that ATE is efficacious, whereas critics have argued for lack of supporting scientific data and that ATE is no more effective than skin undermining in closure of surface defects. OBJECTIVE: To compare and actually quantify gain in skin length after extensive undermining of skin edges alone or in combination with ATE in skin defects. METHODS: Twenty-one consecutive patients undergoing excision and closure of wounds in certain anatomical areas where primary closure is difficult were studied. Actual measurements of the undermined skin before and after ATE were recorded. Immediate problems and long-term follow-up data were analyzed. RESULTS: ATE, in addition to undermining, provides 1:1.61 +/- 0.23 more skin on each margin than undermining used alone. It is effective, easy to perform, inexpensive, and reproducible, with clearly quantifiable increments of skin stretch. Long-term morbidity is minimal with excellent cosmetic results. CONCLUSION: ATE provides a useful tool for closure of skin defects that are resistant to simple primary closure even when deeply undermined. It is simple and easily performed in an office setting without much preparation or special equipment.

Adolescent↗
PubMedDate not supplied

Biorheological features of some soft tissues under a surgical tissue expansion procedure.

The aim of this study was to investigate the effects of a surgical tissue expansion procedure on the biomechanical features of the expanded soft tissues. In this procedure a silicone balloon "expander" is surgically inserted into a tissue and inflated. The tissue mass increases under the stretch of the expander. The increased tissue can then be used as an autologous source for the surgical reconstruction of organs. In this article, dog saphenous neurovascular bundle was used. Expanded saphenous nerves, arteries and veins were harvested and their biomechanical features and ultrastructural, histological changes were studied. The stress relaxation features, the continuous spectrum of relaxation time, and the stress-strain relationship of expanded and control specimens were measured. Results show that within two or three weeks after placement of the expanders, the biomechanical properties of expanded saphenous nerves, arteries and veins began to deviate from those of their controls, and the differences between them were proportional to the volume of inflation; but when the expanding period was 15 weeks or longer, the properties of expanded specimens and their controls became close again. Histological study showed that the content of collagenous fibers in blood vessel walls decreased after expansion. The content of elastic fibers in blood vessel walls first increased, then returned to normal, and finally decreased. Ultrastructural studies showed that when elongated by 25-40%, the expanded nerves had well preserved axons and showed fewer smooth myelin sheaths only in the middle and distal part of the expansion.

Animals↗
PubMed1999

Accurate assessment of tissue expansion in the lower face and anterior neck by a simple measurement technique.

A simple, precise method of clinical estimation for the accurate assessment of tissue expansion in the lower face and anterior neck is described using fixed anatomical reference points. The method makes it possible to select the most suitable size of tissue expander and to decide the optimal timing of operation. By recording the baseline data before expansion and repeating measurements as expansion proceeds, the discrepancy of the expectation between the surgeon and patient concerning the postoperative result can also be minimised.

Cicatrix↗
PubMed2004

The expanded transposition flap: shifting paradigms based on experience gained from two decades of pediatric tissue expansion.

The authors present their experience with the design of expanded skin flaps gained over the past two decades in a large series of 995 expanded flap reconstructions performed in 626 operations in 430 patients. The indications for tissue expansion were giant congenital pigmented nevi (72.7 percent), scar contractures (11.2 percent), and a remainder for a variety of congenital and acquired deformities. Surgical strategies were reviewed retrospectively to determine the location in the body where the tissue expansion was performed, the number of procedures required to accomplish the reconstructive goal, and the design of the expanded flap that was used to reconstruct the involved area. Specific points that were noticed included contour deformities (such as webbing, dog-ears, or decreased limb circumference) following flap reconstruction, anatomic distortions (such as distortion of the eyebrow or the distance from the brow to hairline) following reconstruction, final position of the scars in relation to anatomic landmarks, borders of aesthetic units, and relaxed skin tension lines, and the potential for later scar contracture. Careful examination of reconstruction by region of involvement demonstrated significant advantages in the use of expanded transposition flaps over pure advancement. These advantages and the modifications in the design of expanded flaps for each body region are discussed in a series of representative cases. They emphasize the ability of transposition flaps to dissipate tension away from the flap apex and distribute it more proximally, thus redirecting the tension lines so there is less likelihood of anatomic distortion in the reconstructed area. Also, flaps designed in this manner allow improved contour by avoiding webbing, tenting across concavities, and bunching of skin laterally. The authors conclude that restricting the expanded flap design to advancement alone to minimize potential scarring severely limits the reconstructive capabilities of the added tissue and distracts from the surgeon's ability to accomplish the initial reconstructive goal. The cost of additional incisions is worthwhile to achieve better final contour of the reconstructed part, lesser risk of anatomic distortion, better position of the scars, and lowered risk of scar contracture.

Child↗
PubMed2005

Tissue expansion for the delayed closure of large myelomeningoceles.

OBJECT: Numerous techniques for the soft-tissue closure of large myelomeningoceles have been described. When patients present for delayed repair beyond the neonatal period, the indications for surgery are both different and less immediate. METHODS: Six patients between 6 weeks and 3.5 years of age with defects ranging from 27 to 49 cm2 (mean 37 cm2) were referred to the authors' institution and were successfully treated by direct skin closure after tissue expansion. CONCLUSIONS: In this paper the authors describe the technique and advantages of expansion compared with those of locoregional flaps in this subgroup of patients with myelomeningoceles.

Female↗
PubMed1994

Determination of relative contributions of 'mechanical' and 'biological' creep in tissue expansion using in vivo pressure monitoring: a preliminary report.

This work outlines the theory underlying tissue deformation in response to an applied force and presents a model to evaluate relative contributions to tissue generation from mechanical and biological creep. Using in vivo pressure measurement, this model has been tested with clinical data generated from a heterogeneous series of 10 patients undergoing tissue expansion. Preliminary results indicate that the model proposed is able to fit accurately both in vitro and in vivo data. Extrapolation of the model, in time, may lead to a prediction of the relative contributions of 'biological' and 'mechanical' creep.

Biomechanical Phenomena↗
PubMed1994

Subperiosteal tissue expansion for mandibular augmentation with hydroxylapatite particles: an experimental study.

PURPOSE: The utility of subperiosteal tissue expansion (STE) for mandibular augmentation with hydroxylapatite (HA) particles was evaluated experimentally in two groups of dogs. MATERIALS AND METHODS: Eight grams of solid HA particles were implanted in previously formed bilateral subperiosteal expanded beds on the mandible. In one group, the HA particles were implanted in the intact subperiosteal expanded bed and in the other the newly formed capsule overlying the bone was removed before implantation of HA. RESULTS: Despite marked augmentation with a large number of HA particles, there was neither deformity nor infection of the implants, which maintained the original desired contour. The firm fibrous capsule formed by STE allowed consolidation of the HA particles and prevented their migration. In the first group, although histologic evidence of bony union of the implanted particles was not seen even after 2 months, clinical immobilization of the grafts was achieved in 1 to 2 months. After 1 year, substantial bone growth into the implants was observed. In the second group, clinical immobilization was observed even after 2 weeks. Histologic evidence of bony union of the particles located along the surface of the mandible was observed after 1 or 2 months. In these specimens, however, marked bone resorption of the mandibular cortex, was also noted. No evidence of bone or osteoid formation on the expanded periosteal side was noted in either group. CONCLUSION: These results provide fundamental data regarding mandibular augmentation using STE, and indicate that the subperiosteal expanded bed is an excellent recipient site for onlayed implants.

Alveolar Ridge Augmentation↗
PubMed1994

[Scalp reconstruction after avulsion: emergency microsurgery and secondary tissue expansion. Apropos of 3 cases caused by farming machines].

Total scalp avulsion is an uncommon accident. Three recent cases illustrate our surgical procedure. Small and central hair-bearing avulsed scalps can be treated by secondary scalp expansion (1 case). Large hair-bearing scalp (> 400 cm2) or including aesthetic relief should be treated by microsurgical reimplantation. Venous grafts allow vascular anastomoses beyond the intimal trauma area. Secondary expansion of reimplanted tissue (2 cases) eliminates scalp defects after initial necrosis. Thus, in the cases of total scalp avulsion even with high risk of failure (long time elapsed since injury, significant crush, part being in bad condition, two levels avulsion...), reimplantation has to be performed according to localization and size of avulsion. A secondary procedure with using expansion of the remaining replanted scalp is possible.

Accidents, Occupational↗
PubMed2001

Dynamic tissue expansion of the larynx in a canine model.

OBJECTIVES: To test whether staged, progressive, monitored, dynamic tissue expansion is possible in the larynx and to evaluate its effectiveness in dilating and augmenting constricting cicatricial lesions. DESIGN: Animal study. SETTING: Research facility, tertiary care medical center. SUBJECTS: Thirteen dogs, 3 with laryngotracheal stenosis. INTERVENTIONS: Dogs underwent laryngeal splits, tracheostomy, and insertion of inflatable stents. In 7 normal dogs, stents were progressively inflated by air in predetermined increments during 11 days. In 3 normal dogs and 3 with laryngotracheal stenosis, stents were gradually expanded by water. Stents were kept in place for 21 days. After removal, dogs were observed for 25 days. Five died of complications of tracheostomy. MAIN OUTCOME MEASURES: Airway diameter measured by endoscopy before the induction of stenosis, before the laryngeal splitting procedure, after stent removal, and before euthanasia. RESULTS: The lumen increased, then shrank somewhat after stent removal. In 2 surviving dogs with laryngotracheal stenosis and water-expanded stents, the lumen was 82.5% larger than baseline at stent removal and 71.0% larger at euthanasia. In 2 surviving normal dogs with water-expanded stents, lumen size increased by 50.0% at stent removal, and in 1 dog surviving to day 46, it was 17.0% larger. In 5 surviving dogs with air-inflated stents, lumen size was 39.0% larger at stent removal and 8.0% larger at day 46. Histologically, fibrous tissue developed in the gaps between the splayed margins of the laryngeal cartilages. CONCLUSIONS: The larynx may be dynamically expanded. Although the maximal diameter is not maintained, final cross-sectional areas are larger.

Animals↗
PubMed1992

Tissue expansion in the treatment of tubular breast deformity.

Four cases of tubular breast deformity were treated using tissue expansion. The expanders were inserted through either an axillary or an infra-mammary approach in as low a position as possible. The expanders were then over-inflated and allowed to settle for a period of time before removal and insertion of a permanent implant. We present our experience using this technique and the complications and problems we had to deal with.

Adolescent↗
PubMed1998

[Serial and multiple tissue expansion in burn sequela].

The authors present the case of a 16 year old female with 3rd degree burn sequelae. They describe the surgical steps during the three years of treatment with serial and multiple tissue expansion. From the 9 tissue expanders used with reference capacities of 3350cc, 10350 were achieved. The conclusions point out the utility of this technique, using re-expansion and supraexpansion as one, should be associated with careful surgical planning and constant rapport with the patient.

Adolescent↗
PubMed1987

Tissue expansion in the leg: limits and complications in trauma pathology.

Subcutaneous tissue expansion in the treatment of skin loss was first introduced by Neuman (1957) and subsequently developed by Radovan (1982) as a means of increasing the amount of tissue available for reconstruction. It takes advantage of the elasticity of the skin and its ability to expand when submitted to traction, thereby increasing its surface area. This is achieved by the temporary subcutaneous insertion of prostheses which are gradually expanded with physiological saline injected percutaneously through a valve. Once the required increase in skin surface has been achieved, the prosthesis is removed. Indications and modalities for the use of expanders in the head and neck (Argenta et al., 1983; Manders et al., 1984) and the breast (Radovan, 1982; Argenta et al., 1983) are now well established, but severe skin loss in the distal part of the leg, particularly if due to trauma and accompanied by exposure of the neural structure, may create serious problems of reconstruction. We therefore found it useful to apply this new technique in this situation, having previously adopted it in other parts of the body and obtained good results which would have been difficult to achieve with traditional techniques.

Adult↗
PubMed1990

The creation of a small bowel pouch by tissue expansion--an experimental study in pigs.

Tissue expanders (inflatable silicone balloons) were implanted into a bypassed ileum segment of seven pigs and consecutively filled over 8 to 12 weeks. The mean increase of the volume of the small bowel loops was 12 fold with a maximum of 22.8 times the original volume. The final volume 9 weeks after expander removal still presented an increase of 500%. Histologically there was an increase of the thickness of all layers of the bowel wall, especially in the tunica muscularis. The mucosa showed a value above normal in mean in vitro 14C-resorption capacity per surface area in the reintegrated bowel. Possible clinical applications of the augmentation of the gut by expansion as a rectum substitute after proctocolectomy, as a urinary bladder or stomach substitute, and for the treatment of short bowel syndrome are discussed.

Animals↗