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[The correction of cryptotia with tissue expanders].

Cryptotia is a congenital abnormality represented by the absence of the retroauricular sulcus in its superior portion. As the physiopathology of the problem involves the lack of skin tissue in the superior part of the ear sulcus, Mulliken suggested for the first time in 1988, the use of skin expanders as a method to obtain the extra skin necessary to correct this deformity. We bring forward our experience in the use of skin expanders in the treatment of three patients with cryptotia, bilateral in one of them. The technical aspects of the operations as well as the types of expanders used are described in detail. In all cases the correction of the cartilagenous deformities, freeing of the superior pole of the ear and redefinition of the retroauricular sulcus were performed. There were no significant complications. There was no change of the initial good results after a two years follow-up.

Adolescent↗
PubMed1992

Secondary nerve reconstruction.

Presented is a review of nerve grafting, including the indications, technique, and results. Alternative techniques, including vascularized nerve grafts, tubulization, nerve elongation, and direct muscle neurotization are also discussed.

Humans↗
PubMed1992

Skin expansion as preparation for an opening wedge osteotomy of the mid-foot in arthrogryposis.

A case report is presented in which tissue expansion is used to provide the additional skin needed during an opening wedge mid-foot osteotomy to correct a varus foot deformity in a patient with arthrogryposis multiplex congenita. Tissue expansion is a relatively new method of acquiring coverage for wounds which may have advantages over previous techniques. The risks and drawbacks of this technique will be described in detail.

Arthrogryposis↗
PubMed1992

[Total atrophy of the mandibular alveolar crest. A new therapeutic proposal (the use of a tissue expander) and a clinical case report].

Atrophy of the alveolar crest, meant as a syndrome due to a certain variety of pathogenetic episodes developing in a more or less marked framework of resorption of the alveolar to the maxillary processes, represents an issue of debated and uncertain solution, especially in a view of the extreme degrees of the phenomenon. Various kinds of surgical approach have been suggested over time: among them mention should be made of the onlay graft technique, the osteotomy intervention visor type, the osseous interposition sandwich type, and other methods, which were often the result of a pontered mediation of the above mentioned, and which should have therefore enjoyed their single advantages. In consideration of the different techniques, the results were more or less noteworthy and it was clear, however, that a certain "gap" was still existing between the results aimed to and the results reached. Today, thanks to the tissue-expander technique, combined with the use of alloplasty materials (hydroxylapatite), we can give a new contribution to the solution of this invalidating pathology, thus reaching more complete and lasting results in the plastic reconstruction of the alveolar crest, and avoiding at the same time the disadvantages, even of iatrogenic kind, of an osteotomy intervention.

Aged↗
PubMed1992

[Permanent expanders in esthetic, corrective and reconstructive surgery of the breast].

Since 1986 we used the permanent expandable implant (PEI) as the first choice of prosthesis in breast surgery. The possibilities offered by multiple over-expansions and deflations have been explored: 224 PEI were utilized in 162 patients for aesthetic (38 with bilateral hypoplasia), corrective (20 with asymmetry, tubular breasts or Poland's Syndrome) and reconstructive breast surgery (104 patients for immediate and delayed reconstruction following radical, modified radical, partial and subcutaneous mastectomy). All implants were positioned submuscularly; a latissimus dorsi flap was transposed when pectoralis major was absent or damaged. Either the Becker or the Gibney implant was used. All PEI were immediately or progressively overinflated by 25-80% and then deflated to the planned volume. Twenty-two patients developing capsular contracture were treated by overinflations and deflations with subjective and objective improvement. Many of augmentation mammaplasty patients refused implant deflation to the planned preoperative volume. The over-expansion/deflation process proved to be effective in obtaining ptosis, in maintaining permanent volume symmetry and in keeping the base of tubular breast unfolded.

Adult↗
PubMed1992

[A case of so-called Poland's syndrome].

Pathogenesis, morphology and different associated abnormalities in the so-called Poland syndrome are considered. The surgical treatment adopted in the case recently observed is discussed. In most cases an isolated muscular and breast hypoplasia or aplasia is present so that surgery has the only intent to solve the esthetic problem.

Adolescent↗
PubMed1992

The role of tissue expanders in vaginoplasty for congenital malformations of the vagina.

There are many techniques of vaginoplasty in congenital malformations of the vagina, all of which involve the use of labial and perineal skin flaps. The results are not uniformly satisfactory because of delayed stenosis in many patients. To avoid this complication, we have used labial expansion with tissue expanders to obtain an elastic and sufficiently large skin flap. We recommend this technique in patients with the adrenogenital syndrome associated with varying degrees of virilisation and in other intersex anomalies.

Adolescent↗
PubMed1992

Tissue expanders in the gut: a histological and angiographic study.

A study to assess the effects of an intraluminally placed tissue expander in the rabbit jejunum was performed. Oval expanders (8 cm3) were placed via a midline coeliotomy through an enterotomy on the antimesenteric border of the jejunum. The reservoir was tunnelled subcutaneously through the abdominal wall. Expansion was carried out through this port at 7-10-day intervals using 0.5-cm3 increments. At the end of the experiment, angiography was performed and routine haematoxylin and eosin-stained sections were produced. Angiography revealed an increase in vessel diameter and vascular density of the specimen. Histology showed an increase in villi size, an increase in the number of goblet cells and a marked increase in the thickness of the muscular layer. The possible applications of this technique are discussed.

Animals↗
PubMed1992

[Progress in the use of tissue expanders for defect closure of the body surface--experimental principles].

The principle of soft tissue expansion has been applied in widespread techniques in the field of plastic and reconstructive surgery since Radovan (1976) presented a method in which silicone expanders were subcutaneously implanted. Many experimental and clinical reports have been published since then, dealing particularly with the histomorphology, vascularization, and pathophysiology of expanded skin as well as with surgical techniques. Our own study intends to identify the effects of tissue expanders on the biomechanical, biochemical, and morphological qualities of expanded skin, and to determine the influence of pharmacological therapy during expansion.

Animals↗
PubMed1992

[Progress in the use of tissue expanders for defect closure of the body surface--clinical aspects].

The time-honored principle of tissue expansion has only gained clinical relevance in the past 10 years. Its advantages are that sound tissue of equal texture, color, and quality adjacent to a defect or scarred area can be transposed to treat defects without producing further scars. Especially in the hair covered part of the head, but also in reconstruction of the female breast after mastectomy, in large scars from burns, or in large pigmented nevi, tissue expansion has to be reliable. Only when used in extremities does a higher rate of complication demand a certain restriction.

Adolescent↗
PubMed1992

Maximizing gain from rectangular tissue expanders.

Three different options are proposed to cut the flap after expansion of rectangular tissue expanders. Each method, when used effectively, allows the expander to deliver the full punch of the expansion process.

Cheek↗
PubMed1992

Current concerns with collagen for soft tissue augmentation.

The Scientific Board of the California Medical Association presents the following inventory of items of progress in dermatology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in dermatology that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Dermatology of the California Medical Association, and the summaries were prepared under its direction.

Collagen↗
PubMed1992

In vivo diffusion of lidocaine through tissue expanders.

It has been suggested that the addition of lidocaine to the saline used to fill tissue expanders will reduce the pain often associated with the expansion process. In vitro experiments have shown that lidocaine as it is normally supplied will diffuse through an expander only at a very slow rate, which would probably be inadequate for a clinical effect. We found that the addition of sodium bicarbonate resulted in a substantial increase in the rate of diffusion. Studies in rabbits demonstrated that at a pH of 8.0, 75 percent of the lidocaine dose crossed the silicone elastomer membrane at 24 hours and greater than 95 percent had left the expander at 1 week. We have concluded that intraluminal lidocaine can be effective only when the pH is close to the pKa of lidocaine.

Animals↗
PubMed1992

[Immediate breast reconstruction. A retrospective analysis of 7 years' experience].

The collaboration between oncological and plastic surgeons proved to be essential in the multifaceted treatment of the neoplasms and high-risk lesions of the breast. It guarantees psychological advantages, and improves the quality of life of the patient, who is a candidate for demolition surgery. The authors analyse the results obtained over a 7-year period, through their experiences of 98 immediate breast reconstructions performed after subcutaneous simplex, Patey or Halsted mastectomies. They assessed the validity of this approach due to the brilliant esthetic results obtained, the minimal surgical time, and the low morbidity.

Breast Neoplasms↗
PubMed2004

[Method of the tissue expanding in surgical treatment of the upper extremity deformity].

Results of surgical treatment of 14 patients suffering the segments deformity and the joints contracture of the upper extremity, using the tissue expanding method, were analyzed. The latex expanders as well as those, made according to own model were applied for the dermotension commitment. The peculiarities and modes of operation of the upper extremity tissues expanding were determined. Application of the tissues balloon expanding method during elimination of the upper extremities deformity and the joints contracture had permitted to achieve in immediate period the positive functional and cosmetic results in 83% of observations. In the late period good results were noted in 75% of patients and satisfactory--in 25%.

Adolescent↗
PubMed1992

[Histomorphologic findings in human expanded tissue].

Forty biopsies from 22 patients undergoing tissue expansion were examined histologically. Expanded skin demonstrated a generally unconspicious morphology of the epidermis, dermis and subcutis. Adnexal organs of the skin were preserved. Mean epidermal thickness was increased to 710 +/- 240 microns compared to 624 +/- 215 microns in the controls. The tissue expanders were bordered by a richly vascularized connective tissue capsule with a very variable mean thickness of 795 +/- 712 microns. These histologic findings in human tissues support experimental evidence for a real increase in tissue by expansion.

Adolescent↗