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PubMed1996

[ETE (External Tissue Expansion): a new method for external tissue extension].

The authors describes a new device for external tissue extension (ETE) which will be able to replace or complement tissue expanders. The device consists of many ETE units, each unit consisting of a needle and two friction stoppers counted on a silicone string. Application, optimal tension and final surgical procedure are described. The indications are the same as for tissue expanders, e.g. scars, naevi and previous skin grafts, and also concern the closure of acute fasciotomies. The advantages are numerous: very simple technique, application under local anaesthetics, faster cutaneous profits (5-6 days), inexpensive total treatment, low complication rate.

Humans↗
PubMed1994

Radiologic analysis of the effects of subperiosteal palatal soft-tissue expansion in growing cats.

Palatal soft-tissue expansion might be appropriate for use in cleft palate surgery. Seventy-five cats were divided into four different experimental groups and one control group. Intraoral tissue expansion was started at the age of 14 weeks in normal or scarred mucoperiosteum. The experiment lasted until 24 weeks of age. Serial standardized lateral cephalograms from each animal were digitized, and the results were statistically analyzed. The results indicate that the effects are independent of the presence of scarred tissue, that sagittal growth is impaired by tissue expansion, and that the tissue expander induced resorption of palatal bone.

Analysis of Variance↗
PubMed1991

Continuous versus conventional tissue expansion: experimental verification of a new technique.

Historically, tissue expansion is a prolonged process, typically requiring at least 6 weeks to complete. Recently, interest has increased in shortening this time period. In the current study, a continuous infusion device maintaining constant expander pressure less than capillary filling pressure was used in a canine model in seven dogs to minimize the time period needed to achieve significant expansion. There were no complications, except one device malfunction, corrected by changes in design. The process was shown to be a safe and effective means of producing amounts of expansion similar to traditional methods in approximately 72 hours, with expansion of 28 percent (n = 6) for continuous tissue expansion (CTE) versus 34 percent (n = 6) for a 2-week rapid expansion protocol. This expansion was derived from either stretch of preexisting tissue (46 percent for CTE, 35 percent for 2-week expansion) or recruitment of adjacent tissue. The clinical application of continuous tissue expansion could permit the advantages of tissue expansion to be obtained in many more situations than are currently available to traditional tissue expansion techniques.

Animals↗
PubMed1992

The effect of tissue expansion on dermal fibroblast contraction.

Tissue expansion alters the function of skin cells. We studied the effects of expansion on the contractile function of dermal fibroblasts using an in vitro model, the fibroblast-populated collagen lattice (FPCL). Spherical expanders were placed dorsally in 30 Sprague-Dawley rats; one-half were serially inflated. One, 2, and 4 weeks later, 5 rats from each group were killed. Fibroblasts were cultured from dermis overlying the expanders and mixed with collagen, medium, and serum in petri dishes to form FPCL. Fibroblasts from 5 rats that had not undergone surgery were cultured to make control FPCL. Contraction was assessed by measuring the areas of the FPCL. At 48 hours, FPCL containing expanded fibroblasts had contracted significantly less than those containing unexpanded or control fibroblasts. Four weeks of expansion resulted in less contraction than 1 or 2 weeks. Tissue expansion inhibits the in vitro contractile function of dermal fibroblasts in the rat in a time-related fashion.

Animals↗
PubMed1993

Tissue expansion in the pediatric patient.

Although tissue expansion has many advantages over other reconstructive options, potential complications require consideration. The purpose of this study was to evaluate the experience of tissue expansion in the infant and child. During the 6-year period from 1985 to 1990, a total of 147 expanders were placed in 76 patients. Age of the patients at the time of insertion of the expanders ranged from 1 to 18 years (median, 8 yr). Twenty of the 76 patients studied suffered from complications, a rate of 26%. Despite the high complication rate, complications did not compromise the final result because they occurred near the end of the expansion period and usually involved one of the many implanted expanders. With the appropriate selection of patients, tissue expansion has proved extremely valuable as a reconstructive option in the pediatric patient.

Adolescent↗
PubMed1990

Tissue expansion: past, present, and future.

The history of tissue expansion, technique, indications, and complications are reviewed. A detailed review of delayed tissue expansion's histologic, biochemical, biomechanical, and physiologic changes in the skin is given. There is a net gain in epidermal tissue during delayed expansion. Recent experimental and clinical experience suggests that expansion for 1 to 2 weeks is just as effective as longer delayed expansion for 6 to 8 weeks. A new deviation from standard technique, intraoperative tissue expansion, may have significant implications for dermatologic surgery. Intraoperative tissue expansion is explored in relation to other commonly used techniques of intraoperative load cycling.

Animals↗
PubMed1991

Immediate versus chronic tissue expansion.

A quantitative comparison of the effects on tissues is performed between chronic tissue expansion, intraoperative expansion, and load cycling in a guinea pig model. Intra-operative expansion, which was developed by Sasaki as a method of immediate tissue expansion for small- to medium-sized defects, and load cycling, which was described by Gibson as a method using intraoperative pull, are compared with chronic tissue expansion on the basis of the following four parameters: amount of skin produced, flap viability, intraoperative tissue pressures, and histological changes. The chronically expanded group, which included booster and nonbooster expansions, produced a 137% increase in surface area, or a 52% increase in flap arc length, whereas intraoperative expansion resulted in a 31% increase in surface area, or a 15% increase in flap arc length. The load-cycled group, however, resulted in an almost negligible amount of skin increase. All three techniques exhibit immediate postexpansion stretchback. Flap viability is not impaired by any of the three techniques, in spite of the elevated pressures observed during expansion. Therefore, intraoperative expansion is effective primarily for limited expansion of small defects, whereas chronic tissue expansion still provides the greatest amount of skin increase when compared with other techniques.

Animals↗
PubMed2003

An accelerated approach to tissue expansion for breast reconstruction: experience with intraoperative and rapid postoperative expansion in 370 reconstructions.

Breast reconstruction with tissue expansion is a well-established technique that offers satisfactory aesthetic results with minimal patient morbidity. The traditional period of expansion, however, continues to be a significant source of patient inconvenience and dissatisfaction. The objective of this study was to develop and evaluate a protocol for rapid tissue expansion. A total of 370 breast reconstructions in 314 patients who underwent rapid tissue expansion were retrospectively reviewed. Contraindications to rapid expansion were considered to be previous radiation, mastectomy skin flaps of questionable viability, and an excessively tight skin envelope. All expanders were placed submuscularly and filled to 40 to 50 percent of tissue expander volume. Office expansion was undertaken within 10 to 14 days after the operation and continued on a weekly basis. Each expansion was limited by patient tolerance up to a maximal pressure of 40 mm of water or a volume of 120 cm3. Expansion was considered complete once the expanded breast was 30 to 50 percent larger than the contralateral breast. If required, postoperative chemotherapy was given during the expansion period. Mean patient age was 48 years (range, 23 to 73 years). Two hundred fifty-eight patients had unilateral reconstructions. Three hundred two patients had immediate reconstruction. Mean tissue expander size was 583 cm3 (SD, 108 cm3). Mean intraoperative expansion was 271 cm3, or 46 percent (SD, 9 percent) of the tissue expander size. The first expansion was started 12 days (SD, 3 days) after the operation. The mean volume of each expansion was 88 cm3 (SD, 23 cm3). Expansion was completed in 4.7 office visits (SD, one visit). Mean final expander volume was 672 cm3 (SD, 144 cm3). The expanders were overexpanded by 15.3 percent (SD, 8.4 percent). The mean time between expander placement and the final expansion was 6.6 weeks (SD, 3 weeks). The overall complication rate was 4 percent. Ten patients developed cellulitis, five patients had hematomas requiring drainage, and one expander became exposed. A total of eight expanders were removed: four for cellulitis, one for a hematoma, one because of locally recurrent disease, one because of expander exposure, and one at the patient's request for no medical reason. Intraoperative and rapid postoperative tissue expansion is a safe and reliable technique that offers a significant improvement over conventional techniques. In this accelerated protocol, expansion may be completed in less than 7 weeks. The result is decreased patient morbidity and delays in adjuvant therapy at no detriment to the final surgical outcome.

Adult↗
PubMedDate not supplied

Tissue expansion in pediatric burn reconstruction.

Tissue expansion has gained increased acceptance in postburn reconstruction. In this study, the clinical outcomes for 17 pediatric patients with burns are outlined. A total of 46 tissue expanders were inserted for the reconstruction of postburn scalp alopecia and burn scars. The average size of the soft-tissue defect was 124 cm2, and the mean time to follow-up was 19 months. Overall outcome in most cases was excellent; however, complications were common (37%) and included infection, exposure, port loss, and partial flap necrosis. Five patients in the scalp reconstruction group required transfusions (45%). Tissue expansion in pediatric burn reconstruction is a useful technique, which may yield superb results; however, careful surgical planning is essential to avoid complications.

Adolescent↗
PubMed2006

External tissue expansion using negative pressure in upper-extremity reconstruction.

Soft-tissue expansion in the upper extremities is a valuable technique with increasing indications, which means that using of tissue expansion in reconstruction of upper limb increases day after day. Tissue expansion with implantable balloons is a fairly standard method in reconstructive surgery. This article describes the use of external tissue expansion by using negative pressure in soft-tissue reconstruction of the upper extremities in 40 patients. Valved cups (external expanders) were applied to the skin on one or both sides of the lesion. With the subsequent application of a negative pressure source to the valves, gradual tissue expansion occurred inside the external expanders. When there was enough surface area of the expanded skin to cover the exposed area after lesion excision, the expansion process was stopped and surgery was performed. The upper limit of negative pressure must not exceed -200 mbar. The complications were mild and mainly involved skin blistering. External tissue expansion using a negative pressure technique is simple, safe, cost effective, and associated with good results in the reconstruction of soft-tissue injuries.

Blister↗
PubMed1990

Immediate intraoperative tissue expansion.

We report a modification of the controlled tissue expansion technique, that is, immediate intraoperative tissue expansion. The procedure is performed by placing tissue expanders at the time of surgery. After placement, three to four cycles of inflation/deflation of the expander for 3 to 5 minutes are performed. In a one-stage procedure the stretched skin is then immediately used to close the surgical defect. Three case reports demonstrating the immediate intraoperative tissue expansion technique, in which the Foley catheter balloon was used as the tissue expander, are presented. These cases illustrate that this technique may allow the surgeon to cover defects more easily with less tension and with a better cosmetic result than with other closure techniques.

Adult↗
PubMed1994

Tissue expansion in facial reconstruction.

The tissue expansion technique is advantageous in facial reconstruction because it makes it possible to resurface even wider defects with neighboring skin similar in color and texture and superior to skin obtained elsewhere, thereby surpassing conventional methods. However, there still remain some problems relating to procedural details, such as the selection of tissue expanders and sites of their insertion; the design, elevation, suturing, and fixation of the expanded flap; and the management of free margins such as the lower lip and lower eyelid. In each case, some modification is required with respect to the status of the defect. The experiences encountered in a series of 23 patients are described, with illustration of several representative cases, and advantages and problems are discussed.

Adolescent↗
PubMedDate not supplied

Use of tissue expansion in clubfoot surgery.

Tissue expansion was used successfully to prepare adequate soft tissue for closure following a difficult clubfoot correction. The gradual expansion was done weekly at the outpatient clinics (average 3-4 months). The procedure proved to be useful in severe cases of clubfoot.

Arthrogryposis↗
PubMed1997

Two-dimensional cephalometric analysis of the effects of subperiosteal palatal soft-tissue expansion in growing cats.

The feasibility and possible effects of palatal soft-tissue expansion in palatal repair were studied. A prospective longitudinal animal experiment was performed in 75 growing cats assigned to 5 groups. In 31 cats, a midline defect was made, and bipediced flaps were raised at the age of 8 weeks (stimulated Langenbeck operation) in order to create palatal scars. At the age of 14 weeks, custom-made tissue expanders were inserted palatally in 61 animals. Tissue expansion was performed by weekly inflation in 33 cats (16 without and 17 with scars) for an 8-week period. The remaining 28 cats (14 without and 14 with scars) served as sham groups. A control group was formed by 14 animals (without scars and without tissue expanders). Soft-tissue gain and its effects on maxillofacial growth and development were measured in the midsagittal plane on tracings from standardized lateral radiographs. The effects of the experimental interventions were evaluated for 8 weeks after removal of the tissue expanders. Not all the cats yielded results at all time periods. This study showed that soft-tissue expansion of palatal mucoperiosteum is feasible. The surgically induced scars did not cause significant differences between the different groups in the midsagittal plane, and the data from both expansion and sham groups could be pooled. Significant soft-tissue gain was achieved by the tissue-expansion technique. Iatrogenic side effects were significant anteroposterior growth retardation at the level of the bony palate and an increase in vertical growth of the anterior nasomaxillary height and the posterior skull height during active tissue expansion. After removal of the tissue expanders, some accelerated growth was found in the tissue expansion in the scarred tissue group, with initial correction of the abnormal growth at the cranial base level. It is concluded that palatal soft-tissue expansion is possible in growing cats. This technique, however, impaired maxillofacial growth and development.

Analysis of Variance↗
PubMed2006

How does the meristem of sunflower capitulum cope with tissue expansion and floret initiation? A quantitative analysis.

The coordination between floret initiation and tissue expansion has been studied and quantified in the apical meristem of sunflower (Helianthus annuus) plants grown under different light availability. A method was developed to quantify tissue expansion in the meristem during floret initiation from measurements of meristem area, number of florets and primordium size. Initially, floret initiation and tissue expansion occurred simultaneously at the meristem surface. The duration of this phase remained unchanged across environments, whereas the rate of tissue expansion varied greatly. Floret initiation rate depended on meristem initial size and tissue-expansion rate. Thereafter, floret initiation continued without tissue expansion in the meristem, resulting in a rapid decrease of meristem area. A set of equations was proposed to predict floret initiation rate and floret number as a function of the rates of tissue expansion in the meristem before and during floret initiation. This formalism demonstrated the role of tissue expansion in determining the final number of florets, and provided a framework to analyse the response of floret initiation to genotype and environment.

Biomass↗
PubMed1996

Breast reconstruction through tissue expansion.

While not appropriate for all patients, tissue expansion is a popular alternative to using muscle flaps for breast reconstruction. Tissue expansion is a method of breast reconstruction that uses an inflatable expander to stretch the remaining skin and tissue following a mastectomy. The advantages of breast reconstruction via tissue expansion are many. Plastic surgical nurses are key in providing an adequate patient education program that will assist patients to comply with the postoperative expectations. Complications, although uncommon, do occur and usually can be treated for a satisfying result.

Female↗
PubMed2000

Tissue expansion in head and neck burn reconstruction.

The advent of tissue expansion has provided a useful tool for the reconstructive burn surgeon. As with many new techniques, there was an initial wave of enthusiasm surrounding the introduction of tissue expansion to burn reconstruction in the 1980s. High complication rates and many dissatisfying results followed. After early widespread use of tissue expansion, the authors have settled on a more refined approach to the reconstruction of head, neck, and facial burns. Today, head and neck burn reconstruction is accomplished best with a combination of skin grafting, local flaps, and occasional free flaps in addition to tissue expansion. In carefully selected head and neck burn patients and in many burn alopecia patients, tissue expansion can provide excellent functional and aesthetic results, with minimal donor site morbidity.

Adolescent↗
PubMed1998

Versatility of tissue expansion in head and neck burn reconstruction.

Tissue expansion has enjoyed a wide range of applications since the technique was popularized by Radovan in 1978. A useful application of tissue expansion is in the reconstruction of the head and neck following burn injury. From July 1986 to March 1990, 25 patients underwent head and neck reconstruction for burn injury using tissue expanders. A retrospective chart review was undertaken. The average age was 24 years, and the age range was 9 months to 46 years. Fourteen males and 11 females were treated. A total of 51 expanders were placed, and the most common locations of the expanders were the cheeks, neck, and scalp. The time period from burn injury to reconstruction averaged 22.7 months. Operative time for placement of the expanders ranged from 40 to 180 minutes. The average time for full expansion was 86 days. Major complications were those that required an additional operative procedure, and included one dehiscence, one infection, and one port failure. The major complication rate was 12%. Minor complications were those that did not interrupt the expansion process or require any operative intervention. The minor complication rate was 32%, and included three cases of exposure, three cases of wound dehiscence, one seroma, and one ruptured implant. Minor complications were frequent, although when managed conservatively they did not compromise the overall outcome. Despite a major complication rate of 12%, final reconstruction was achieved in all patients. This retrospective review demonstrates that tissue expansion is a versatile adjunct in the treatment of burn injuries to the head and neck, and reconstruction in this area can be accomplished with excellent cosmetic results.

Adult↗