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PubMed1993

A history of tissue expansion. Concepts, controversies, and complications.

BACKGROUND: Tissue expansion has become a widely used adjunct in reconstruction of the skin. OBJECTIVE: To trace the history of the concept of tissue expansion from the ancient to the latest medical literature. METHODS: We reviewed the technologic developments in the materials and methods of tissue expansion. RESULTS: Tissue expansion is of clinical importance and can be understood by the biochemical, biomechanical, and histologic features of expanded skin. CONCLUSION: Tissue expansion is becoming widely used and accepted and its continued use under many circumstances is justified by the experimental and clinical results.

Animals↗
PubMed1987

Breast reconstruction by tissue expansion.

The techniques of tissue expansion for use in breast reconstruction is described, together with the results of its use in 33 patients. The advantages and disadvantages of tissue expansion in relation to other currently favoured techniques are discussed. It is concluded that tissue expansion represents a major advance in the field of breast reconstruction.

Adolescent↗
PubMed2001

[Investigation on skin retrograde degeneration after tissue expansion].

OBJECTIVE: To study the effects of tissue expansion on tissue damage and retrograde degeneration. METHODS: 9 cases of conventional intermittent tissue expansion (CITE) and 9 cases of continuous pressure-controlled tissue expansion (CPTE) were chosen for the study. In creating of the expanded flaps, tissue samples were taken for histopathology, molecular biology and transmission electron microscope (TEM) examinations. RESULTS: Capillary bleeding, elastic and reticular fiber proliferation, arteriole thrombosis, fibroblast apoptosis and collagenolysis were observed after expansion. Retrograde degeneration was obvious in CITE group and acute lesion was obvious in CPTE group. CONCLUSION: Expansion stimulation induces tissue damage and retrograde degeneration, which indicates that the time for conventional intermittent expansion should be shortened and too fast continuous expansion is harmful.

Humans↗
PubMed1997

Tissue expansion with endoscopy.

Tissue expansion is a time-honored technique in plastic surgery. However, while it is possible to rectify quite severe problems, the technique is not free of complications (e.g., extrusion) and, moreover, it can be a lengthy procedure, often taking months. Endoscopy is increasingly being used in plastic surgery and has the advantage that large areas can be dissected using only small incisions. However, in endoscopic plastic surgery the main problem is the lack of an optical cavity. This means that special retractors are needed to keep skin and fat tissue lifted. This paper describes a technique for the placement of tissue expanders during endoscopy. Incisions are not made in the area that is to be expanded and, thus, there is no risk of extrusion and tissue expanders can be fully inflated intraoperatively. A further advantage is that the procedure reduces patient discomfort to a minimum.

Adult↗
PubMed1995

Tissue expansion for Apert's syndactyly.

Tissue expansion is useful in post-traumatic reconstruction in the upper extremity. Its use has also been proposed in congenital syndactyly. Expanded local skin flaps would in theory provide locally appropriate cover, obviating the need for skin grafts. We report a retrospective assessment of tissue expansion in the management of Apert's syndactyly. Despite theoretical benefits, tissue expansion significantly increased the required number of operations. The technique was associated with an unacceptable rate of complications, and generated inadequate skin flaps, and web spaces requiring a higher rate of revision than traditional techniques. Despite expectations, tissue expansion for Apert's syndactyly proved disappointing and is not advocated.

Child, Preschool↗
PubMed1989

A control unit for maximal-rate continuous tissue expansion (CTE).

Subcutaneous or submuscular tissue expansion has become a major tool for the reconstructive plastic surgeon in the repair of difficult wounds and in breast reconstruction. This technique can provide additional or replacement tissue with good match in color, sensation, texture and adnexal characteristics. A major limitation of the technique is the time required for periodic tissue expansion to the required volume in the clinical setting, typically taking from a few weeks to several months. Conceptually, the maximum rate possible for safe clinical tissue expansion would result from continuous maintenance of tissue expander pressure just below capillary filling pressure (continuous tissue expansion, CTE). A control device with this capability would have important clinical and research applications. A self-contained portable control unit (patent pending) for CTE has been designed, fabricated, and testing initiated in a dog model. The 4-lb unit includes a 250-cc fluid reservoir, power pack, pressure transducer (Microswitch 160 PC), pump (Spalding 701A), feedback circuits and memory (2-lb power pack, 2-lb controller and reservoir). Preselected constant pressure (15-50 mmHg +/- 0.1 mmHg) can be maintained in a tissue expander with a maximal flow rate of 16 cc/hr for approximately 18 hours before change of the NiCad battery pack. A digital memory records pressure and volume infused and transfers this data to a Macintosh computer after completion of expansion. Verification of this prototype control unit is presently underway. Initial data suggests that the time required for complete filling of a subcutaneous tissue expander in a dog model can be reduced to approximately 72 hours. Several potential clinical applications and variations of this device are discussed.

Animals↗
PubMed2005

Tissue expansion in pediatric patients.

Tissue expansion has become a well-recognized technique for reconstructing a wide variety of skin and soft tissue defects. Its application in the pediatric population has allowed the plastic surgeon to achieve functional and aesthetic goals that were previously unobtainable. This technique can be applied to a variety of reconstructive problems, including the management of giant congenital nevi and the secondary reconstruction of extensive burn scars. This article reviews the use of tissue expansion in the pediatric population, with particular emphasis on indications, operative technique, and regional considerations. The authors also address concerns that have been expressed about the complications associated with this technique.

Child↗
PubMed1987

Immediate breast reconstruction with tissue expansion.

Between October of 1983 and June of 1985, 31 patients underwent primary breast reconstruction with tissue expansion. Tissue expansion was utilized for breast reconstruction when the remaining muscle and skin following modified radical mastectomy was insufficient to accommodate a prosthesis that matched in size and shape the opposite breast. All expanders were placed beneath an investing muscular pocket created by elevating the pectoralis major and serratus anterior. Postoperative expansion began within 1 week, and the breast was expanded to double the volume of the opposite breast. Twenty-two patients have completed their reconstruction with a mean follow-up in 7 months. There were nine complications, including five deflations and four infections. All patients have remained Baker I or Baker II. Creating ptosis to match the breast was accomplished by placing the expander below the rectus fascia and superiorly advancing this expanded tissue at the time of prosthesis placement. Primary breast reconstruction with tissue expansion following modified radical mastectomy is safe, simple, and produces a breast with excellent shape, size, texture, and patient satisfaction.

Breast↗
PubMed1991

Soft-tissue expansion in lower extremity reconstruction.

Soft-tissue expansion in the lower extremities is typically well tolerated. The more proximal one is--that is, the closer to the thigh and buttocks--the easier and less complication prone the expansion will be. It is another valuable technique for resurfacing the lower extremity and for reconstructing defects in contour and in skin character. There are limitations to this technique, which generally is most useful in late reconstructions. Intraoperative expansion has no place in lower extremity reconstruction. Soft-tissue expansion may be limited by an unsuitable geometry or the sheer size of defects. It should not be used next to open wounds. Soft-tissue expansion offers significant advantage in that the coverage of a defect will be replaced with tissue like that lost. Seldom does one see necrosis of advanced flaps, so that there is little risk of tissue loss in using this modality. There is an excellent vascularity to the flaps and an excellent character to the skin. In addition, in this cost-conscious era, soft-tissue expansion is quite cost effective, and in many cases the procedures can be conducted on an outpatient basis with a minimum of hospitalization, if any. With care to select patients properly, design carefully, and conduct expansion in a leisurely fashion, soft-tissue expansion offers a valuable means of reconstructing both large and small lower extremity defects.

Adult↗
PubMed1998

Intraoperative tissue expansion in eyelid reconstruction.

OBJECTIVE: Chronic tissue expansion is a well-accepted modality for increasing available tissue for reconstructive surgery. In rapid intraoperative tissue expansion (RITE), a tissue expander is used intraoperatively to increase the available tissue area for defect closure. The use of the ubiquitous and inexpensive Foley catheter has previously been reported as a tissue expander in RITE. In this paper, the authors examine the application of the Foley catheter for RITE in oculoplastic surgery. DESIGN: Case series. PARTICIPANTS: Twenty-six patients (ages 50 to 87) with eyelid defects from various causes underwent reconstruction using RITE. INTERVENTION: Using this technique, the tip of a #14 French Foley catheter is trimmed, keeping the balloon intact. The balloon is inserted under a skin-muscle flap. Counter traction is applied, and the balloon is filled with saline until the flap blanches. The balloon is inflated twice for 5 minutes with a 1- to 2-minute rest period between expansions. This provides increased tissue area for reconstruction of periocular defects. MAIN OUTCOME MEASURES: The linear extent of the eyelid defect was measured prior to and after expansion with RITE. A comparison was made between the two measurements. RESULTS: The linear extent of the eyelid margin defect decreased by 36% after RITE. CONCLUSIONS: Rapid intraoperative tissue expansion with a Foley catheter is a means of providing increased tissue area for reconstructive surgery of the eyelids and periorbital region. This technique provides excellent tissue match for color, texture, and thickness. The technique decreases the size of the incised and undermined skin-muscle flap and the tension needed for wound closure.

Aged↗
PubMed2006

[Repair of skin soft tissue defects with new overlapping tissue expansion techniques].

OBJECTIVE: To improve the efficiency of skin soft tissue expansion with the overlapping tissue expansion techniques. METHODS: From June 2003 to March 2005, 5 cases of skin soft tissue defects were treated with the overlapping tissue expansion technique-two overlapped expanders in one soft tissue pocket, which was different from the traditional technique--one expander in one soft tissue pocket. Five patients included 3 males and 2 females, aging from 11 to 28 years. The defect was caused by scar of forearm in 2 cases, by melanotic nevus in 1 case and by cicatricial baldness in 2 cases. The disease course was 1.5 to 24 years. The defect size ranged from 12 cm X 5 cm to 13 cm X 12 cm. RESULTS: Skin expansion process was satisfactory and skin defect was completely repaired with the expanded skin tissue in one operation in 5 cases. After operation, the wound of donor-recipient site healed by first intention. All patients were followed up from 3 to 15 months, no contracture, pigmentation and scar occurred at the expanded skin area. The long-term appearances were satisfactory. CONCLUSION: Compare with the traditional tissue expansion techniques, the new overlapping tissue expansion techniques can apparently improve the efficiency of skin soft tissue expansion. It is suitable for the patients whose expandable skin is limited or no more skin tissue can be dissected near the skin defect and who need more expandable skin to repair skin defect.

Adolescent↗
PubMed1988

Soft-tissue expansion in the lower extremities.

Soft-tissue expansion enjoys ever-wider use, but to date an experience using this technique in the lower extremity has never been presented. We reviewed our first 16 patients to describe the indications and contraindications for the use of tissue expansion in the lower extremity. Guidelines evolved from study of the data. Soft-tissue expansion merits consideration for coverage of problem wounds, in preparation for removal of large benign lesions, and for the repair of contour defects. The operator should know that an open wound below the knee predicts a complication if soft-tissue expansion is attempted in that location. In the thigh, incisions can be confidently placed at the edge of the defect. In every location, large expanders should be chosen so that they are as long as or longer than the adjacent defect. The increase in circumference of the limb should be followed. Simple designs for advancement flaps usually work well. As our experience has grown, reconstruction using soft-tissue expansion in the lower extremity has become safer and the results more predictable through better patient selection and diligent monitoring of intraluminal pressures, even if only by ensuring that the patient is always comfortable. Soft-tissue expansion has a role in reconstruction of the lower extremity.

Adolescent↗
PubMedDate not supplied

The relative risk of tissue expansion in the pediatric patient with burns.

Tissue expansion has been successfully used for reconstruction after burn injury. The purpose of this study was to investigate the relative risk of complications of tissue expansion in the pediatric population. Children with burns who underwent reconstruction with tissue expansion were studied (37 expanders in 14 patients). Patients without burns who were also treated with tissue expansion served as a comparative group. The patients without burns included children with congenital anomalies (70 expanders in 37 patients) and acquired problems (40 expanders in 25 patients). Complications occurred in 10.8% of the expanders in the burn group, in 11.2% of the expanders in the congenital anomalies group, and in 7.5% of the expanders in the acquired problems group. No significant difference between the groups was noted. We conclude, therefore, that the child with burns is at no greater risk of complications from tissue expansion than are other children.

Adolescent↗
PubMed1990

Clinical applications of tissue expansion in head and neck surgery.

Tissue expansion offers a new frontier in head and neck reconstruction in that it provides the capability of creating additional new skin for restoration of defects with skin of identical color, thickness, and appendages. The applicability of tissue expansion is only beginning to be appreciated as it is used in various aspects of head and neck surgery. Currently, the technique is most frequently used in scalp surgery for correction of male pattern baldness. Other uses of tissue expansion are in cranial facial surgery and expansion of distant, regional, or microsurgical flaps. Perhaps its greatest value from a reconstructive perspective, however, is in providing new skin for reconstruction of various facial defects through the use of primary wound closure or a multitude of local flaps.

Cheek↗
PubMed1988

Tissue expansion in children.

Tissue expansion is a useful tool in reconstructive surgery. It permits the correction of large skin lesions by expanded cutaneous or fascio-cutaneous flaps, well vascularised and matching in colour, texture and thickness. We report our results in 12 children. There was a relatively high complication rate.

Burns↗
PubMed1989

[Technic of tissue expansion].

The technique of tissue expansion is rapidly developing. It resolves certain problems encountered in plastic and reconstructive surgery, in the scalp, for example, which constitutes an ideal indication. A correct strategy and technique, together with well defined indications allows a very significant reduction in the complication rate. The choice of prosthesis and its location also play an important role. There are many indications in the scalp, but tissue expansion may also be useful in Poland's syndrome, in giant naevi in children and for expansion of certain flaps. Rapid intra-operative expansion also appears to be a promising technique.

Cicatrix↗