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A simple clinical guide is provided for calculation of the size of tissue expander necessary for any given defect. The use of an expanded transposition flap is demonstrated and its advantages expounded.
OBJECTIVE: To evaluate a new reconstruction method for grades V and VI defect with flap by skin soft tissue expansion technique. METHODS: From May 1998 to September 2003, 8 cases of serious thumb defect were treated, including 6 males and 2 females, aging 18-27 years. The defect was caused by crush injury of machine in 6 cases and hot crush injury in 2 cases (5 cases of grade V and 3 cases of grade VI). The expander was placed under the tenor skin and soft-tissue. And then normal saline was infused to expand the skin and soft tissue gradually till it was available for thumb reconstruction. Iliac autograft was fixed to residual thumb stump and covered with flap produce by expanded skin and soft-tissue. Postoperative rehabilitation was carried out. RESULTS: All reconstructed thumbs were alive. After 3-24 months follow-up, all reconstructed thumbs were with good sensation, appearance and durable. Two-point discrimination was less than 5 mm. The functions of opposition, extend, abduction and endoduction were better in grade V thumb defect than in grade VI thumb defect. Bone union was achieved within 3 to 4 months. CONCLUSION: It is a convenient-to-operate and reliable method for thumb reconstruction. It is an alternative new reconstruction method for grades V and VI, thumb defect.
A strategy of surgical treatment for male pattern baldness has been conceived using a combination of flaps and tissue expansion. This strategy has been tested on ten cases and the results presented herein. Based on the early experience guidelines have been formulated which allow reliability and predictability of results, as well as selection of appropriate patients.
The gradual mechanical distention of tissues in the extremities using inflatable balloons allows elimination of local defects or expansion of known extremity donor sites to facilitate other reconstructive requirements. Complication rate are higher for extremity tissue expansion, and proper caution must be adopted if this concept is to be valuable for applications in the extremities.
By recalling the imperatives of auricular reconstruction, the author analyses the indications for tissue expansion in this area. This expansion can be performed preoperatively or intraoperatively, directly on the ear, indirectly, away from the ear. In the light of his experience, illustrated by three clinical cases, the author considers preoperative indirect expansion to be the most useful, by placing the expander underneath the scalp.
Twenty-eight women scheduled for a breast reconstruction with tissue expansion were randomly divided into two groups. In the first group, the breast tissue was expanded rapidly, i.e., starting 1 week postoperatively on a daily basis; in the other group the breasts were expanded slowly, i.e., starting after 2 weeks, once each week. The expansion periods were 14 and 37 days, respectively. In both groups, the expansion volume was about 200 percent of the final breast prosthesis. The expanders were replaced by textured, gel-filled implants after 3 months. Follow-up examinations were performed after 1 year and 3 years to evaluate breast softness. An objective method, applantation tonometry, was used, and relative breast compressibility was calculated. The capsular contraction rate after 1 year was 45 percent in the rapid expansion patients and 23 percent in the slow expansion patients; after 3 years, it was 31 percent in the rapid expansion group and 33 percent in the slow expansion group. There was no statistically significant difference between the two groups at any time. Irradiated patients included in the study did not achieve poorer results. The results already obtained after 6 months remained stable up to 3 years after the implantation of the permanent prosthesis.
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A modification of the Abbe-McIndoe technique for the treatment of congenital absence of the vagina, using a cylindrical tissue expander wrapped in a mesh split-thickness skin graft, instead of a rigid silicone mold, is presented. The expander was kept in place for a period of two to six months and the functional result was 100 percent in all the six patients treated. Our experience led us to change the design of the expander (cylindrical, without ring, 10X4 centimeters) and to place the valve in the inner thigh as the best site for the valve. The age range of the patients was 18 to 27 years, and the final result was good or very good in five of the six women. Only one patient has occasional dyspareunia, which does not prevent sexual intercourse.
Intra-abdominal tissue expansion routinely occurs physiologically with pregnancy and may be seen in a variety of pathologic states. There are a number of situations where additional abdominal wall would be helpful. We encountered such a situation in a set of ischiopagus conjoined twins. In effect, separation would result in an abdominal wall deficit of approximately 50%. As an alternative to intraperitoneal air, we inserted two 1,000 mL tissue expanders through a subcostal incision at 6 months of age. Over the ensuing 7 weeks, each expander was gradually inflated to greater than capacity (1,250 mL each). Except for initial ileus, there was no difficulty in expanding the abdomen to enormous proportions. At the time of surgical separation, the expanders were removed and the available abdominal wall tissue almost closed directly on both children. Closure was complete in one baby, whereas a small upper abdominal wall defect was left in the other, necessitating Marlex reinforcement. There has been a recent explosion in the use of tissue expanders in reconstructive surgery. From head to toe, soft tissue can be expanded to be used as flaps, to close donor defects, or both. With this report, its use intra-abdominally is described. Future application is limited only by our ingenuity and imagination.
In this paper, the subject of surface-area gain in tissue expansion is approached from three sides. With the help of a mathematical approach, the theoretical increase in surface area was calculated in relation to the specifications of the expanders. In an in vitro model, these mathematical data were confirmed to be reliable. To determine the real surface-area gain that takes place in vivo, measurements on pigs were performed. It appears that only about 35 percent of the mathematically expected increase in surface area takes place. Moreover, a clear difference was observed between the surface-area gain for the different shapes of tissue expanders.
The temporary tissue expander can generate an excess of full-thickness skin that can be recruited into an adjacent area of tissue deficiency caused by scar contracture. The creation of a pseudobursa enhances the functional improvement gained by this technique. Now in its developmental stage, tissue expansion carries an alarming complication rate (33%), but we expect refinements in technique to diminish this percentage.
The outcome of 25 children who underwent reconstruction of the head and neck with tissue expanders is described. Fourteen boys and 11 girls with a mean age of 6.2 years (range 3-11 years) had 36 tissue expanders inserted. Five of the expanders extruded and five children suffered other expander-related complications. The best aesthetic results were achieved in the scalp and the poorest results occurred where expanded neck skin was transposed into the face. Tissue expansion is a useful method for reconstruction of the head and neck in burned children. However patients require careful selection in order to achieve optimal results. Meticulous attention to detail is required to reduce the incidence of complications.
The use of tissue expanders has considerable merit and wide applicability in breast reconstruction. The majority of patients who have undergone conservative modified radical mastectomies in the past fifteen years can be reconstructed without extensive flap procedures. The expansion prosthesis greatly increases the number of patients who can be reconstructed simply with a submuscular prosthesis.
Guided tissue regeneration techniques are used to create new bone around implant defects and to augment edentulous ridges prior to implant placement. A new technique, tested successfully in baboons, utilizes soft tissue expanders prior to implant placement and tissue regeneration procedures.
PURPOSE: The use of gastrointestinal tissue for augmentation cystoplasty is associated with numerous complications. We previously reported the development of a system in which ureters were progressively dilated and used for ureterocystoplasty. We have now applied a similar system for the progressive expansion of native bladder tissue. We investigated whether the expanded bladder tissue retained normal functional and phenotypic characteristics. MATERIALS AND METHODS: Urodynamic studies were performed in 5 beagle dogs and the bladder was divided horizontally into a superior bladder neo-reservoir, and an intact smaller bladder inferiorly with both ureters left intact and draining. A silicone catheter was threaded into the newly formed, superiorly located neo-reservoir, and connected to an injection port which was secured subcutaneously. A saline antibiotic solution was injected daily into the palpable injection port 4 weeks after surgery, dilating the neo-reservoir through the silicone catheter. Baseline and weekly cystograms were performed. Urodynamic studies of the neo-reservoirs were done immediately before sacrifice. Animals were sacrificed 3 months after the initial intervention and the bladder was examined grossly and microscopically. RESULTS: Within 30 days after progressive dilation, the neo-reservoir volume was expanded at least 10-fold according to radiography and cystometrograms. Urodynamic studies of the dilated neo-reservoirs showed normal compliance in all animals. Microscopic examination of the expanded neo-reservoir tissue revealed normal histology. A series of immunocytochemical studies demonstrated that the dilated bladder tissue maintained normal phenotypic characteristics. CONCLUSIONS: The system of progressive dilation is effective in expanding bladder tissue which is able to retain normal phenotypic and functional characteristics.
Since 1987, One hundred and fifty-four patients suffered from alopecia, neck and facial scar, and nasal defect had been treated with skin soft tissue expansion. The incidence of complication was decreased markedly, compared to previons report which was 11.7%. Two cases of this group were given up this procedure. The lessous learned from these case were as following. Strictly evaluated the case according to the indication, examined the expander carefully, improved the techniques to inbed the expander and infilled the sailine, those of which could obtain satisfactory result.
This article reports a three-dimensional (3D) digital color scanning system used in the measurement of facial soft tissue expansion. This system consists of digital scanning equipment, software for stereolithographical (STL) forms and nonuniform rational B-spline (NURBS) surfaces, and a computer-aided design program. Accurate data for the area of scar excision and the expanded cervicofacial flap were obtained by using this measuring system in a young patient with scar contracture of the face. This technique can accurately model the reconstruction and make plastic surgery planning a truly interactive procedure.