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[Experimental concept of periprosthetic membrane neo-flap with axial vascular pedicle].

This study was designed to demonstrate that progressive inflation of an expansion prosthesis placed under the epigastric pedicle of the rat induced the formation of vascular connections between this vessel and the periprosthetic membrane. 17 Wistar rats were operated under general anaesthesia. The 7 cc prosthesis was implanted into the inguinal fold and the valve was placed in a dorsal position via limited incisions. 11 rats were studied, divided into 3 series: 3 control rats (non-inflated prosthesis), a series in which the prosthesis was inflated up to 20 cc (at a rate of 5 cc per week) and a series in which the fate of the capsular flap isolated as a vascular island flap in a prefabricated silicone block was studied. The assessment was threefold: clinical, microradiographic after injection of lipiodol into the epigastric artery and histological. The clinical and microradiographic studies demonstrated the reality of the blood supply of part of the periprosthetic membrane and its connections with the epigastric axial pedicle. This membrane surface, constituting a real biological flap prefabricated by expansion, corresponds to the peripedicular zone (2 x 1 cm). The viability of the island flaps was confirmed after 8, 14 and 21 days. Histological studies confirmed the hypervascularisation and richness of the collagen fibres as a result of expansion.

Animals↗

[Immediate breast reconstruction with tissue expander].

The technique of immediate breast reconstruction, using the tissue expander and replacing it with a permanent silicone prosthesis, has been applied with increasing frequency during the past several years. We chose this technique for immediate breast reconstruction because of its simplicity, rapidity when combined with mastectomy, and good esthetic results. We have performed 29 immediate breast reconstructions in the past 1.5 years in patients ranging from 22 to 72 years (mean 47). The insertion of the tissue expander added only 20-30 minutes of operating time for the mastectomy, and did not prolong hospitalization. Before we began to replace the expander with a permanent silicone prosthesis there were complications in 4 patients (14%). These included development of a seroma in 3, 1 of which became infected 40 days after insertion of the tissue expander, and capsular contraction in a patient who had previously had radiotherapy to her breast. The case with the infection was the only failure and the expander had to be removed. Immediate reconstruction of the breast is easily performed and can be of tremendous psychological benefit to mastectomy patients. Chemotherapy or radiotherapy are not contraindications to this type of reconstruction.

Adult↗

[The indications, technics and results of the use of tissue expanders in pediatric surgery].

We review our experience in tissue expansion in twenty-four pediatric patients. The most frequent indications for the use of tissue expanders included congenital nevi and burn scars, they were also used with success in alopecia, congenital abdominal wall defects, mammary hypoplasia and microtia. Tissue expanders were always placed subcutaneously. Both, surgery and body deformity during expansion, were well tolerated. We found complications in five cases, but only in one patient treatment was interrupted. Results were considered excellent in nineteen cases.

Adolescent↗

[Growth stimulus of the paranasal sinuses with tissue expanders].

Various congenital craniofacial deformities show hypoplastic paranasal sinus. The Treacher Collins, the Apert and Crouzon Syndromes and the Hemicraniofacial Microsomy, among others, are typical examples of this observation. Stimuli to the growth of the paranasal sinus during the facial growth period could sensibly improve the treatment of deformity, or even avoid later surgeries. Since their introduction in plastic surgery, tissue expanders are progressively acquiring greater importance in many areas of the specialty. This is a safe and simple alternative to solve difficult cases. It has been demonstrated that real tissue growth occurred in all layers of cutaneous tissues subjected to expansion, including the induction of mitoses. Recent works showed that microorbits could be corrected through the introduction of expanders in their orbits. The authors proposed that to stimulate the growth of paranasal sinus, tissue expanders should be introduced bilaterally in the maxillar, frontal, ethmoidal and sphenoidal sinus, which should promote the development of the face. The expansion induced should be controlled and gradual through injections of small amounts of saline in each session. This project includes the cautious design of the size and shape of the expanders as well as the care with adequate draining of the sinusal cavity and the possible mechanical atrophy of the mucosal lining of the sinus.

Humans↗

[Clinical application of expanded forearm reverse dorsal interosseous artery island flap].

The island flap based distally on the posterior interosseous artery has been proven to be available for the correction of severe cicatricial contracture deformity of the ipsilateral hand. However, the main disadvantages of this flap are the second donor area deformity and muscle or tendon adhesions after skin grafting. Both these complications may be ameliorated by means of tissue expansion to obtain a secure blood supply to the flap. The surgical procedure has been performed in 7 patients with satisfactory result since August 1989.

Adult↗

Using tissue expanders in spinal surgery for deficient soft tissue or postirradiation cases.

Prior irradiation and scarring can complicate wound closure following spinal surgery. Implanted tissue expanders were used six times in four patients to aid skin closure. Three patients had prior irradiation for cancer, and one had myelomeningocele. The average interval between placement and removal of the expanders was 46 days. Two late failures occurred because of prominent hardware. These expanders may provide adequate myocutaneous covers following spinal surgery in difficult cases.

Adult↗

The use of tissue expanders for induction of facial skeletal growth.

We present a case of successful orbital expansion with a tissue expander in 1 patient. This method will be valuable in preventing the facial deformities of anophthalmia and microphthalmia. The method was successful from a technical standpoint because of scleral investment of the expander and because of relative fixation of the expander by passage of the filling tube through the lateral orbital wall. The early experience of this patient confirms our expectations of successful orbital expansion based on the natural history of patients with orbital tumors or congenital glaucoma and on the experimental work of other investigators.

Child, Preschool↗

Controlled tissue expansion with guided bone regeneration.

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.

Alveolar Bone Loss↗

Are synthetic prostheses really inert? Preliminary results of a study on the biocompatibility of Dacron vascular prostheses and Silicone skin expanders.

This study investigates the histo-pathologic reactions induced by implant of prostheses in Dacron knitted double velour and skin expanders in Silicone elastomers. Particular attention was paid to the effect of these reactions on the tissue itself. In the case of vascular prostheses it was found that fibrous connective tissue tended to accumulate in and around the prosthesis. We also observed widespread lymphohistiocytic infiltration and occasional plasmacytes. Numerous foreign body granulomas were found to be grouped around the filaments of plastic material. The prosthesis itself seemed to be composed of filaments of different calibre, fragmented into particles of varying size. Thus the structure of the prosthesis was modified and discontinued along its whole length. A similar granulomatous inflammatory reaction developed in the case of the skin expander, probably due to the leakage of particles of plastic material through the expander wall, which however did not seem to be affected by the tissue reaction. The findings indicate the need for more detailed research into the material used for prostheses, aimed at determining what modifications the tissues can produce in the synthetic material. Also, it is necessary to follow a multidisciplinary approach which takes into consideration the data available from the chemistry of polymers, fluid mechanics and cell biology.

Adolescent↗

[Coping with illness and body image following different surgical techniques in breast cancer].

Coping and body image were studied in 80 patients with breast cancer. We compared three groups, who had undergone different operative strategies: temporary expander prothesis (n = 19), excisional biopsy (n = 20) and modified radical mastectomy (n = 40). Instruments were: the Herschbach coping questionnaire, the Strauss and Appelt body image questionnaire and a semi-structured interview. Patients after excisional biopsy showed significantly less illness-related stress than the other two groups, both in the number of all items named (p less than 0.02) and in the weighted total (p less than 0.05). Patients after modified mastectomy had chosen a different, "unfavourable" pattern of coping mechanisms than patients after expander prothesis or excisional biopsy: more resignation (p less than 0.05), less fighting and talking (p less than 0.05, respectively). In the body image questionnaire, no significant difference was found. However, in the semi-structured interview, patients after mastectomy mentioned more frequently that they avoided looking at the scar (p less than 0.05). These results underline the importance of preoperative counselling.

Adaptation, Psychological↗

Hair transplantation and bald-scalp reduction.

The art and science of hair transplantation have come a long way since its introduction in 1959. Both the technique and instruments have been greatly improved, thus offering the patient an excellent cosmetic result that will last a lifetime.

Alopecia↗

Controlled expansion of peripheral nerves: comparison of nerve grafting and nerve expansion/repair for canine sciatic nerve defects.

The inherent disadvantages of nerve grafting have made it necessary to find alternative techniques for treating segmental nerve loss. This study compares the techniques of nerve grafting and nerve expansion/repair for the management of nerve injuries with segmental nerve loss in an animal model. Bilateral segmental sciatic nerve defects were created in eight dogs. On one side a 2-cm segment was excised and replaced with a nerve graft; on the other side a 2-cm defect was created with ligatures and the nerve underwent preliminary expansion and then repair. Eighteen months later nerve conduction velocity (NCV), gastrocnemius contraction force (GCF), and muscle weight (GMW) were determined for the seven surviving animals. NCV for the expanded repair was 58.66 +/- 34.18 m/sec and 47.73 +/- 7.93 for the grafted repair (p = 0.4); GCF was 619.04 +/- 353.70 gm for the expanded repair and 726.80 +/- 415.78 gm (p = 0.2) for the grafted repair; and GMW was 82.80 +/- 5.68 gm for the expanded repair and 109.55 +/- 20.63 gm (p = 0.02) for the grafted repair. The data suggest that: 1) conventional tissue expansion techniques can be used successfully to repair segmental peripheral nerve defects; 2) NCV and GCF are comparable for grafting and expansion/repair techniques although GMW is significantly higher in the grafted group; and 3) nerve expansion/repair may prove to be a useful alternative to grafting.

Action Potentials↗

Forehead tissue expander.

The use of the forehead flap for nasal reconstruction has long been used by reconstructive surgeons. A case is presented in which comprised forehead skin is utilized following expansion by a tissue expander.

Basal Cell Carcinoma↗

[Cutaneous expansion in burns sequelae].

This technique of skin expansion with inflatable balloons has rapidly become generally used since Neuman's and Radovan's work. It offers new prospects for the treatment of the sequellae of burns as it allows increasing the surfaces of the remaining unaffected skin and using them to cover the excision of scar lesions by local or remote flaps. Experience with more than 500 implanted balloons is assessed, demonstrating very satisfactory general results in spite of a still too high number of complications, which increasingly refined techniques aim at reducing.

Burns↗