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PubMed1987

Use of external reservoirs in tissue expansion.

The use of tissue expanders having external reservoirs is presented. Twenty-four patients had 36 tissue expanders placed in the scalp, face, neck, upper limbs, chest, and lower limbs. All patients, apart from one, were taken to completion. This patient had erosion of the skin over expander and was only partially completed after removal of the expander. Apart from one instance of deflation at the end of the expansion where the skin could still be used, there were no other complications, in particular, no infections. The advantages of this technique are reduced operating time, ease of injection into the reservoir, lack of pain for the patient, early detection of reservoir or filling tube junction leakage, and lack of complications associated with the reservoir. This procedure is not recommended on at least theoretical grounds for breast expansion, where a permanent implant is to be inserted.

Dermatologic Surgical Procedures↗

PubMed1989

Stretching and tissue expansion for rhytidectomy: an improved approach.

Intraoperative expansion of the skin of the face supplies additional tissue that permits closure of the face lift incision with minimal tension. This paper presents the findings in rhytidectomy patients over the last 3 years using both intraoperative stretching and intraoperative stretching combined with tissue expansion utilizing the Man face lift expander. Sixty-seven patients underwent rhytidectomy surgery, of whom 50 were treated with stretching techniques alone and 17 were treated with the combined stretching and expansion method. The patients' ages ranged from 28 to 78 years. Results indicate that the patients treated with combined stretching and expansion had significantly more skin removed. This new technique appears to offer significant clinical advantages over usual face lifts.

Adult↗

PubMed1992

The impact of adjuvant radiotherapy and cytotoxic chemotherapy on the outcome of immediate breast reconstruction by tissue expansion after mastectomy for breast cancer.

In an attempt to evaluate the impact of radiation therapy and cytotoxic chemotherapy on the outcome of immediate breast reconstruction by tissue expansion after mastectomy a prospective study on 32 patients was performed. The radiation therapy significantly worsened the surgical outcome, because the irradiated patients more often had pectoral muscle stiffness making the expansion more painful and the reconstructed breast too small, hard and with insufficient ptosis to obtain a natural breast mould. These results indicate that this technique should be avoided in patients likely to receive postoperative adjuvant cytotoxic chemotherapy and radiation therapy, thus reducing the indication to a small group of patients undergoing mastectomy for widespread ductal carcinoma in situ.

Adult↗

PubMed1990

Controlled tissue expansion of a groin flap for upper extremity reconstruction.

A large upper extremity defect in an 8-year-old girl was resurfaced with an expanded groin flap. Tissue expansion allowed complete coverage of the defect while minimizing the donor deformity. Pretransfer expansion of pedicled flaps offers an alternative to free-flap reconstruction of complex upper extremity defects. This is especially valuable in the pediatric patient, in whom donor-site morbidity can be significant.

Child↗

PubMed1986

Tissue expansion as an adjunctive technique for the management of difficult wounds.

Replacement of lost or injured tissues with similar tissues is a major goal of the reconstructive surgeon. A relatively new modality, tissue expansion, appears to be an helpful adjunct in achieving this goal by providing tissues for reconstruction that are near at hand, possess similar characteristics to the lost tissue, and can even enhance vascularity within an ischemic area. Although the technique is a useful one, its indications and contraindications are incompletely defined. We have used this technique 65 times in 42 patients during a 2 1/2 year period. The overall complication rate has been 22 percent, similar to other reconstructive techniques, but the consequences of these complications have been relatively minor and have not, for the most part, added significantly to patient morbidity.

Adolescent↗

PubMed1987

Controlled tissue expansion for correcting amputation stump scar.

The authors describe the recently developed technique of tissue expansion to correct a problem-causing amputation scar. The technique involves the use of a progressively distended silicone bag placed under the skin to gradually stretch the skin so as to provide sufficient excess skin to allow plastic closure and elimination of the scarred tissue that had interfered with the use of a prosthesis.

Adult↗

PubMed1988

Correction of cryptotia using tissue expansion.

The anatomy and surgical correction of cryptotia are reviewed. Another technical procedure using retroauricular tissue expansion is presented. This method allows release of the auricle and construction of the auriculocephalic sulcus without the problems associated with older soft-tissue techniques, e.g., incomplete correction, multiple scars, poor color match of skin grafts, and donor-site morbidity.

Adolescent↗

PubMed1985

Enhancement of tissue expansion by anticontractile agents.

To evaluate the effect of anticontractile agents on the rate of tissue expansion, guinea pig back skin was expanded while being treated with various anticontractile agents. Expansion was carried out using standard percutaneous inflatable skin expanders modified by the addition of a catheter to deliver the anticontractile agents papaverine or cytochalasin D. Expansion proceeded for 25 days with one or other of the substances being infused through the catheter; saline was used in a separate control group. Measurements of the rate and extent of expansion showed that there was a statistically significant increase in these parameters for the experimental groups as compared with saline controls. Histologic examination of the expanded tissue suggests that the cellular basis for this phenomenon may involve the relaxation or inactivation of contractile fibroblasts in the fibrous capsule surrounding the expander.

Animals↗

PubMed1998

Enhancement of wound tissue expansion and angiogenesis by matrix-embedded fibroblast (dermagraft), a role of hepatocyte growth factor/scatter factor.

This study examined the effects of matrix-embedded human fibroblasts, a predominant cell type in the injured tissue, on the tissue expansion and angiogenesis. Using a co-culture technique, it was demonstrated that the presence of matrix-embedded fibroblasts (Dermagraft) significantly enhanced the expansion of human wound tissue in a 3D gel system over a period of 10 days. Using a rat aorta ring assay, fibroblasts also significantly stimulated the growth of new vessels from the ring and also enhanced the motility of human vascular endothelial cells. This effect of fibroblasts was neutralised with anti-HGF/SF antibody. HGF/SF protein was detected in both supernatant and cell lysate of the fibroblasts by bioassay and Western blotting, mRNA for HGF/SF was detected in the fibroblasts by RT-PCR. HGF/SF secreted by the fibroblast was able to stimulate the phosphorylation of cMET, HGF/SF receptor. It is thus concluded that matrix embedded fibroblasts are capable of stimulating wound healing and this effect is attributed to HGF/SF, produced by the cell.

Journal Article↗

PubMed1989

Refinement of the fibular osteocutaneous flap using tissue expansion.

The most serious objection to many otherwise advantageous cutaneous donor areas may be the cosmetic deformity from the exposed skin graft that is required for wound closure. Any contemplated fibular osteocutaneous composite tissue transfer that would result in such an obviously large donor defect therefore deserves consideration for pretransfer tissue expansion or simultaneous placement of tissue expanders at the time of flap elevation. Post-transfer expansion of the lateral lower leg donor site following semi-urgent reconstructions has provided significant aesthetic improvement, allowing the transformation of skin-grafted or open areas into a more acceptable linear scar.

Adult↗

PubMed1995

Tissue expansion in neurosurgical reconstructive technique: case report.

BACKGROUND: Various reconstructive techniques using hair-bearing scalp to manage unsightly scalp defects have been described. In 1983, Fonseca and in 1984, Horowitz emphasized the use of galeal-pericranial flaps in scalp wounds with exposed bone. In 1986, Matthews and Missoten described early tissue expansion to close a traumatic defect of the scalp, and in 1990 Kiyono placed tissue expander in a pocket adjacent to the defect that was covered with Marlex Mesh. METHODS: The authors present a case of 23-year-old man with a scalp laceration over a depressed fracture of the skull and a dural tear, after a traffic accident. The repair procedures at another hospital failed, resulting in an area of scalp necrosis with a cerebrospinal fluid (CSF) leak. At our observation, the reconstructive technique using hair-bearing scalp with tissue expander was performed to manage unsightly scalp necrosis. Moreover the neurosurgical treatment was necessary to avoid the complications of the CSF leak. CONCLUSIONS: A 9-year review showed more than 40 patients treated by this technique that allows a pericranial flap of every size. When scalp defects are too large, the tissue expander allows good aesthetic results.

Adult↗

PubMed1988