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[Reconstructive treatment with multiple tissue expanders after an extensive skin burn of the lower extremity].

The paper refers to an experience of skin reconstruction of a widely damaged lower limb as result of a hot water burn injury in a young girl. Evidence is given to adopted reconstruction times, and to the decision not to recur to flap transposition by skin innests, but to the tissue expansion technique, also to avoid new aesthetic damages. The peculiarity of the experience is in the employment of a multiple number of tissues expander, to meet characteristic problems of the limbs related to this reconstructive technique, particularly in presence of heavy burn scars. It is also widely illustrated the operatory phases and times which are necessary to obtain an optimal functional result, with very satisfying aesthetic final appearance.

Adult↗
PubMed1993

Prefabricated microvascular shoulder free flap for forehead reconstruction.

In a case with a large forehead defect following tight scalp bandaging in childhood, a prefabricated microvascular shoulder free flap was used for reconstruction. A free forearm fascial flap, with the radial artery and the concomitant vein as pedicle, was harvested and inserted under a subcutaneous pocket opened in the left shoulder region which served as the future "prefabricated free flap". In addition, a tissue expander was placed in this pocket to provide the necessary tissue expansion to enable primary donor site closure.

Adolescent↗
PubMed1993

Surgical treatment for congenital absence of the vagina using tissue expansion.

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.

Adolescent↗
PubMed1993

[Immediate reconstruction after radical mastectomy for breast carcinoma with a Becker-type expander prosthesis].

In recent years, the breast has won importance from the female psychology point of view. After ablative surgery for cancer, the loss of the breast gives rise in the woman to a feeling of refusal of her new body shape. Reconstruction produces positive feelings in the patient. The best-used surgical technique for operable breast cancer is modified radical mastectomy. An immediate reconstruction of the missing breast is considered when the following conditions are fulfilled: desire for reconstruction, age of the patient, clinical and pathologic evaluation (tumor size-tumor grade-lymph-node status). After modified radical mastectomy with "en bloc" removal of axillary lymph nodes, an immediate reconstruction is performed by lining the surfaces with human fibrin glue (Tissucol) followed by the insertion of a prosthesis of appropriate size (Becker Expander Mammary Prosthesis-Type 1) in the subserratus-subpectoral position. Human fibrin lining reduces the incidence of capsular contracture and effusion production. A suction drain is placed in the axillary area and is removed after 5 days. The use of expanding-type prostheses means that the patient must return for further expanding. When the pathologic features are negative, the delayed nipple areola reconstruction is possible with the full-thickness skin grafts in the groin or in pre-existent appendectomy incision. By this procedure, adjuvant chemotherapy or radiation therapy can be performed if required. From 1987 to 1991 the procedure has been performed in 35 cases of mammary neoplasm (mean age 40 years) at INRCA Department of Surgery of Ancona). No evidence of adverse effect on the natural course of the breast disease for have been seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Experimental effects of intraorbital tissue expansion on orbitomaxillary growth in anophthalmos.

A skeletal growth study evaluating an intraorbital tissue expander as a globe replacement in anophthalmos was conducted in an infant animal model. Twenty-one 21-day-old kittens were equally divided into the following three groups: a control, a unilaterally enucleated, and an enucleated-expanded group. Postoperative three-dimensional computed tomographic scans were obtained at 5 months of age immediately before study termination. Linear orbital, orbitomaxillary, and zygomaticomaxillary dimensions were measured on the scans and compared at necropsy with orbital volume assessment on the dry skulls. Control animal orbits averaged 21.5 mm in height, 21.0 mm in width, and 5.1 cm3 in orbital volume, and an orbitomaxillary-zygomaticomaxillary height-to-width ratio of 31.0: 24.5. The control side, its contralateral side, and the contralateral orbits of the treated sides were not significantly different. By study completion, enucleation resulted in a significant loss of orbital volume (mean, 1.9 cm3; p < 0.001) confirmed by deficient orbitozygomaticomaxillary measurements. The expanded orbits showed no loss of volume (mean, 5.2 cm3; p > 0.1) and normalization of all linear midfacial structures. This study demonstrates that early expansion emanating from within the orbital soft tissue positively affects both the skeletal and lid anomalies associated with congenital globe loss or early enucleation.

Animals↗
PubMed1993

Carbofilm-covered prostheses in plastic surgery: preliminary observations.

The optimal interface between an implant and the host organism is that which minimizes uncontrolled and irregular growth of fibrous tissue around the foreign material. One way to achieve this goal is to coat the outer surface of the implant with a biocompatible material. A thin film of turbostratic carbon (Carbofilm, Sorin Biomedica, Saluggia, Italy) can be applied as a thin coating on tissue expanders and breast implants made of silicone elastomers. The success of biologic trials with such implants in rats and cytologic studies with murine and human fibroblasts encouraged us to employ the Carbofilm technology in clinical situations. Preliminary results indicate that Carbofilm-coated implants satisfy the requirements of an ideal alloplastic material and induce a minimal periprosthetic inflammatory reaction, with the formation of a thin, soft, pliable, fibrous capsule around coated gel-filled silicone implants.

Animals↗
PubMed1993

Incidence of autoimmune disease in patients after breast reconstruction with silicone gel implants versus autogenous tissue: a preliminary report.

OBJECTIVE: To test the hypothesis that there is a higher incidence of autoimmune disorders in patients who have undergone breast reconstruction with silicone gel implants rather than autogenous tissue. DESIGN: Prospective study. SETTING: Tertiary referral center dealing exclusively with cancer. PATIENTS: All female breast cancer patients who underwent breast reconstruction between January 1986 and March 1992. Patients were nonrandomly assigned to breast reconstruction with one of the following four methods: (1) silicone gel implant only, (2) latissimus dorsi flap with implant, (3) latissimus dorsi flap without implant, and (4) transverse rectus abdominis flap. The first two groups made up the implant cohort and the last two groups the autogenous tissue cohort. Selection of reconstructive method was made on clinical grounds and was based on both physician and patient preference. MAIN OUTCOME MEASURES: Documented diagnosis of autoimmune disorder by Board-certified rheumatologist. RESULTS: Three hundred eight implants were used in 250 patients, and 408 reconstructions with tissue were performed on 353 patients. The two groups were similar in age and tumor stage. The two groups contributed 615.8 and 663.4 person-years of follow-up, respectively. One patient from each group (< 0.5%) had a documented occurrence of an autoimmune syndrome requiring therapy. Both cases were considered mild, and after initial low-dose steroid therapy, both patients are now off steroids. CONCLUSION: The incidence of autoimmune disease in mastectomy patients receiving silicone gel implants is not different than in patients who had reconstruction with autogenous tissue.

Adult↗
PubMed1993

Combined tissue expansion: clinical attempt to decrease pain and shorten placement time.

Tissue expansion can be characterized as a unique reconstructive procedure that takes advantage of the intrinsic ability of tissues to stretch and, in some instances, to grow in response to expansive forces. The efficacy of combined intraoperative expansion to obtain sufficient expanded tissue more rapidly was tested in reconstructions of the extremities, and the comparison between conventional and combined expansion was performed observing five parameters: initial injected volume, pain score, duration of pain, total period of expansion, and histologic findings. We treated 22 patients with conventional expansion and 29 with combined expansions. The latter approach enabled us to overexpand the expanders initially and was associated with lower pain scores than conventional expansion. Furthermore, in the combined expansion group, shortening of the duration of pain was statistically significant in the upper arm (p < 0.05) as well as in the lower leg (p < 0.01). In this group, the total expansion period also was significantly shorter (p < 0.01). Histologically, only minor differences were seen between groups. In this study, intraoperative expansion combined with subsequent rapid overinflated expansion proved to be superior to conventional expansion not only in reducing expansion time but also in decreasing pain. We consider the following effects to contribute to this result: (1) increased skin elasticity due to repeated intraoperative load cycling, which leads to easier expansion of the skin and less irritation of the sensory nerves, (2) improved survival and vascularization of skin flaps due to the "delayed-flap" phenomenon, and (3) prevention of shrinkage of the expanded skin and widening of scars due to overinflated expansion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1993

Comparison between rapid and slow tissue expansion in breast reconstruction.

Fifty women scheduled for breast reconstruction surgery with tissue expansion were randomly divided into two groups. In the first group the tissue was expanded rapidly, i.e., once a day, starting 1 week postoperatively, and in the other group it was expanded slowly, i.e., once a week, starting after 2 weeks. The expansion periods were 14 and 41 days, respectively. In both groups the expansion volume was about 200% of the final breast prosthesis. The expanders were replaced by textured, gel-filled implants after 3 months. Follow-up examinations were made after 6 and 12 months to evaluate breast softness. A subjective method, Breast Augmentation Classification, and an objective method, applanation tonometry, were used and showed good correlation. Subjectively, the capsular contraction rate after 1 year was 33.5% in the whole series: 40% in the rapid expansion group and 27% in the slow expansion group. Objectively, the capsular contraction rate was 50.5% in all patients: 60% in the rapid group and 41.5% in the slow group. There was no statistically significant difference between the two groups at any time with either method. Irradiated patients included in the study did not show poorer results. The results obtained after 6 months remained stable up to 12 months after the implantation of the permanent prosthesis. The importance of objective evaluation to compare different series is discussed.

Breast Neoplasms↗
PubMed1993

[Symmetry, ptosis and a new infra-mammary border in the reconstruction of the breast with a tissue expander].

The aim of this procedure is to obtain a permanent prosthesis (after mastectomy and the insertion of a tissue expander) that is similar to the contralateral breast in volume, morphology and inframammary border. The technique involves aspiration of the tissue expander fluid until the desired volume is obtained and the measurement of the fluid which indicates the volume of the prosthesis to be inserted. Given the satisfactory results obtained, the intention is to continue adopting this procedure.

Adult↗
PubMed1993

Prefabricated flaps using tissue expanders: an experimental study in rats.

The aim of this study was to determine if muscle vascularized pedicle flaps (MVP flaps) elevated in expanded tissue on the rat would survive to the same or greater area than flaps elevated in nonexpanded tissue. The animals were divided into three groups: group I (n = 10), with a tissue expander; group II (n = 10), with a tissue expander but not expanded; and group III (n = 10), with a thin silicone sheet (Biobrane). The mean surviving area of group I (96.6 +/- 3.6 percent) was statistically higher than that of group II (73.2 +/- 24.7 percent) (p < 0.05) and group III (59.5 +/- 25.1 percent) (p < 0.005). These experiments demonstrate that there is a larger area of flap survival in expanded muscle vascularized pedicle flaps than that found in nonexpanded flaps in rats. The mechanism of increased vascularity associated with tissue expansion is still unclear, but microangiography of flaps showed increased vascularity of the pedicle itself, especially in group I.

Angiography↗
PubMed1993

Immediate breast reconstruction after mastectomy.

Immediate breast reconstruction after mastectomy can be performed safely with a low incidence of complications. There is no evidence that reconstruction with a submuscular implant interferes with subsequent oncologic care, followup, or outcome for patients.

Adult↗
PubMed1996

Use of tissue expanders for wound closure of spinal infections or dehiscence.

Posterior spinal incisions that are made through skin and have been compromised by radiation or prior incisions can be difficult to obtain stable closure. In addition, if a wound has developed a postoperative infection or wound dehiscence caused by poor wound healing, severe complications can develop. The technique of expanding adjacent normal skin with implantable tissue expanders has been used in select cases with success. The techniques and indications for tissue expansion in posterior lumbar wounds is reviewed and several case reports presented.

Adult↗
PubMed1995

[Unusual use of a tissue expander].

Postpneumonectomy syndrome is a rare but serious complication. Mediastinal shift leads to compression of the remaining main bronchus. Repositioning of the mediastinum in the midline allows partial or total recovery. To maintain mediastinal position, the pneumonectomy space must be filled by a tissue expander.

Bronchi↗
PubMed1996

[Surgical treatment of superficial vascular malformations. Indications for tissue expansion].

The aim of this work was to demonstrate the feasibility of surgical exeresis of superficial vascular malformations using tissue expansion. A retrospective analysis of data from 15 patients who underwent surgery over a 9 year period for arteriovenous (n = 6) and venous malformations of the trunk and limbs was made. Indications for treatment were pain in six patients or complications of an arteriovenous malformation. Twenty-eight expanders were used in 15 patients. Most of the complications observed (25% of the cases) were minor. The program had to be interrupted due to complications in only one case (7%). Mean duration of tissue expansion was 105 days (30-165). Mean delay to cicatrization was 40 days and mean duration of the treatment program was 156 days. Indication for surgical exeresis of superficial vascular malformations can be widened due the contribution of tissue expansion. With acquired experience, the risk of complications has been reduced. The duration of the treatment protocol is the main drawback.

Adolescent↗
PubMed1995

[The use of expanders in soft-tissue plastic-reconstructive surgery].

Thirty-six years ago, Neumann was the first to practically implement skin expansion by means of subcutaneous rubber balloon inflation. After discovery of the silicone elastomer (1970), Padovan initiated the wide application of expanders in practice. Ever since then, the latter have conclusively demonstrated their contribution to plastic and reconstructive surgery in handling skin and soft-tissue defects in all parts of the body. The preparation and utilization of expanders are closely linked to the goals pursued, and evolve through several stages: 1) selection of the size and number of expanders, 2) choice of expander consistent with the valve type, 3) choice of the site and orientation of the incision for subcutaneous puch formation for the expander, 4) depth of expander insertion, 5) size of the punch for expander, valve and tube. After insertion of the silicone balloon (expander) subcutaneously, its inflation with serum is begun. Recently, early (for 24 hours) and quick (for 7-10 days) inflation of the expander is resorted to. The tolerance of both tissues involved, and patient is the basic criterion for practical implementation of the technique described. As any operative intervention and procedure, the use of expanders is associated with a number of complications. In general they are divided in: 1. minor--where discontinuation of the expansion process is unnecessary, but it is prolonged until the planned extension is attained, and 2. major--necessitating complete discontinuation of the process of expansion and performing additional procedures.

Humans↗
PubMed1996

Tissue expansion vaginoplasty for treatment of congenital vaginal agenesis.

BACKGROUND: A patient with congenital vaginal agenesis was unsuccessful in the use of dilation to create a vaginal orifice and rejected the option of a buttock graft. CASE: Two tissue expanders were introduced beneath the labia majora bilaterally and slowly expanded over 4 weeks. Redundant labial tissue was advanced as a bipedicle flap to line the neovagina created intraoperatively. Postoperative stent placement and dilation resulted in a vaginal canal lined by full-thickness mucosa exceeding 8 cm in depth. CONCLUSION: A modified method of tissue expansion vaginoplasty using a bipedicle flap is an option for the surgical creation of a vaginal orifice.

Adult↗