Need a pizza meshed skin? A simple expansion device.
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The suture tension adjustment reel. A new device for the management of skin closure.
The initial clinical experience with a new device, called the Suture Tension Adjustment Reel (STAR), is described. The historical precedence and rationale underlying linear tissue expansion is presented. Case reports illustrate the use of the STAR for preoperative tissue stretching, for intraoperative tissue stretching, and for tissue mobilization as applied to scalp reduction surgery. The multipurpose device is a safe, simple, and reliable adjunct to sutured surgery. It is of value in the general management of tensioned and nontensioned skin closures.
Adult↗
Cranial vault distraction: its illusionary effect and limitation.
BACKGROUND: Distraction osteogenesis has some advantages, such as less hazardous complications, less scarring, and fewer bone defects. However, it has not been fully accepted yet because of a unidirectional expansion along the distraction device. Because cranial expansion is limited by scalp tension and soft-tissue scarring, undercorrection of the cranium and relapse of the vault deformities have occasionally been seen on long-term follow-up. These patients also had so much bone defect that the donor bone was inadequate for immediate revisions, and dissection under the scalp was complicated. METHODS: The authors used distraction osteogenesis to treat 12 cases of craniosynostosis. Five patients were syndromic (two cases of Pfeiffer's syndrome, two cases of Crouzon's disease, and one case of Apert's syndrome), and seven were nonsyndromic (four cases of brachycephaly, two cases of scaphocephaly, and one case of plagiocephaly). RESULTS: After only unidirectional expansion without vertical reduction, the shape of the cranium was satisfactorily improved, which might have been an illusion caused by the relative reduction attributed to the elongation by the distraction osteogenesis and, in brachycephaly, alteration of the patient's head position resulting from inclination of the facial plane by forehead advancement. However, in scaphocephaly, the unique deformity in the occipital and frontal regions remained after simple distraction. Distraction osteogenesis should be applied for a narrow cranium because the bone defect and scalp closure could pose problems. Radical reshaping should be used in cases of sufficient donor bone and scalp closure. Although additional surgery is unavoidable for device removal, minor revisions can be performed for revision of the irregularity at that time. CONCLUSION: Except for prolonged treatment, based on minimally invasive operations, distraction cranioplasty might be applied extensively in cases of craniosynostosis.
Acrocephalosyndactylia↗
[Skin expansion screw and skin expander--modern techniques for increasing possibilities in adjacent flap-plasty and defect closure].
There are various techniques for reconstructing skin and soft-tissue defects, among them skin expansion. During the past three years, we have tested a skin-stretching device based on the lag-screw principle of Hirshowitz et al. (1993). We have compared both techniques. The complication rate of both groups was acceptably low.
Equipment Design↗
Long-term results in maxillary deficiency using intraoral devices.
Cleft lip and palate patients often present maxillary retrusion and class III malocclusion after cleft repair. Maxillary distraction is a technique that can provide simultaneous skeletal advancement and expansion of soft tissue. Twelve patients with cleft maxillary deficiency due to cleft lip and palate were treated by Le Fort I osteotomy and two intraoral distraction devices that were activated after 4 days of latency period, 1mm per day on both sides. Long-term clinical and cephalometric evaluation of one and two years demonstrate stable results concerning the skeletal, dental and soft tissue relations. In this paper we discuss the advantages of distraction osteogenesis as a method for treatment of maxillary deficiency in cleft patients in terms of stability and relapse. The indications for maxillary distraction: (1) Moderate and severe retrusion that needs large advancement as in cleft lip and palate patients. (2) Forward and downward lengthening of the maxilla with no need for intermediate bone graft. (3) Growing patients. In conclusion, maxillary distraction in moderate or severe retrusion, as in cleft patients offers marked maxillary advancement with long-term stability.
Adolescent↗
LeFort I soft tissue distraction: a hybrid technique.
Distraction osteogenesis of the craniofacial skeleton has greatly enhanced traditional osteotomies and bone grafting techniques. The obvious drawbacks to an external distraction device are visibility and awkwardness. A hybrid technique of maxillary distraction for soft tissue expansion and formation of regenerate, combined with rigid internal fixation, is proposed. This technique permits maxillary advancement that may be unattainable by traditional methods and obviates the extended use of external hardware during latency and consolidation of the regenerate. It also allows for optimization of the dental occlusion. The study group was composed of five patients with severe skeletal class III malocclusion who had combined maxillary distraction followed by rigid internal fixation. The average age at the time of LeFort osteotomy was 17 years, with a range of 13 to 19 years. The latency period ranged from 1 to 5 days, and distraction was done at the rate of 1 mm/d in all patients. After the proposed advancement was attained, all patients had reoperation, consisting of distractor removal, optimized interdental relationships with intermaxillary fixation, and placement of rigid internal fixation. The average anterior-posterior maxillary advancement was 11.6 mm, with a range of 10 to 13 mm. Lateral cephalograms and clinical examination showed no relapse at an average follow-up of 25 months, with a range of 5 to 40 months.
Adolescent↗
Implant reconstruction in breast cancer patients treated with radiation therapy.
BACKGROUND: Implant reconstruction in breast cancer patients treated with radiation therapy is controversial. Prior studies are limited by older prosthetic devices, reconstructive techniques, and radiation therapy protocols. METHODS: A retrospective review was performed of patients who underwent tissue expansion and implant breast reconstruction performed by a single surgeon after mastectomy for breast cancer from 1996 to 2003. Complications and aesthetic results were compared between patients who received radiation therapy and those who did not. RESULTS: A total of 104 patients (123 breasts) who underwent mastectomy and implant breast reconstruction were included in the study. Twenty-seven patients (27 breasts) received either premastectomy or postmastectomy radiation therapy for breast cancer. All patients who received radiation therapy did so before completion of their implant reconstruction. Complications ultimately requiring prosthetic device removal or replacement, as well as total complications (those requiring prosthetic removal or replacement and those not requiring prosthetic removal or replacement), were more frequent in breasts that received radiation than breasts that did not (18.5 percent versus 4.2 percent for complications requiring prosthetic removal or replacement, p < or = 0.025, and 40.7 percent versus 16.7 percent for total complications, p < or = 0.01). Breast symmetry was significantly better in patients who did not receive radiation compared with those who did (p < 0.01). CONCLUSIONS: Implant breast reconstruction in patients who receive radiation therapy is possible but associated with more frequent complications and decreased aesthetic results. However, the present results compare favorably to those reported in prior studies. Improved results in the present study may be attributable to the use of newer prostheses, staged breast reconstruction with initial tissue expansion, total muscular coverage of the implant, and modern radiation therapy protocols.
Adult↗
Ureteral tissue balloon expansion for laparoscopic bladder augmentation: survival study.
BACKGROUND AND PURPOSE: The search for the perfect urinary bladder substitute continues. Despite their inherent limitations, intestinal segments remain the commonest material for bladder reconstruction. The ureter, with its transitional epithelium, may be the ideal tissue to augment the bladder. Ikeguchi et al reported the feasibility of chronic ureteral balloon expansion by open surgery (J Urol 1998;159:1665). Herein, we propose a completely minimally invasive approach to balloon overdilate a segment of juxtavesical ureter incrementally and to use this in-line tissue-expanded ureteral patch to augment the bladder laparoscopically. MATERIALS AND METHODS: In five female pigs, a novel ureteral expansion balloon device (Microvasive, MA) was inserted percutaneously and advanced antegrade into the juxtavesical ureter. The device has two channels: one for balloon inflation and the other for draining the kidney. After progressive ureteral expansion over a 3- to 4-week period, laparoscopic augmentation ureterocystoplasty was performed. Animals were euthanized at 15 days (N = 1), 1 month (N = 1), 2 months (N = 1), and 3 months (N = 2). RESULTS: Percutaneous balloon device placement was technically successful in all five cases (mean operating room time 52 minutes). The mean volume of the tissue-expanded ureter at 1, 2, and 3 weeks was 12.9 cc, 60.3 cc, and 171.8 cc, respectively. Laparoscopic augmentation ureterocystoplasty with (N = 3) or without (N = 2) concomitant subtotal cystectomy was technically successful in all five cases without any open conversion. The mean operative time was 126.5 minutes, and the mean blood loss was 29 mL. Postoperative complications consisted of one case each of pyelonephritis and ureteral stricture. At autopsy, the mean capacity of the bladder was 574 mL, and the P(ves) at maximum capacity was 14 cm H(2)O. Histologic examination of the tissue-expanded ureter revealed regenerated transitional epithelium and muscle hypertrophy. CONCLUSIONS: Chronic ureteral tissue expansion can be carried out safely and efficaciously. The expanded tissue is thick, healthy, and vascular, with histologic features of normal transitional epithelium and muscle hypertrophy and hyperplasia. This expanded ureteral tissue can be used to augment the bladder with laparoscopic techniques. Such augmented bladders do not show significant shrinkage and possess urodynamic characteristic of normal capacity and normal compliance over a follow-up of 3 months.
Anastomosis, Surgical↗
[The application of external skin expansion in the soft tissue donor site].
OBJECTIVE: To overcome the insufficiency of donor tissue for repairing a large postburn defect. METHODS: The donor site was pre-expanded with an external expansion device in 54 clinical cases. RESULTS: The expansion process was uneventful. The external expansion had delay effect that enabled the flap to be transferred with greater length to width ratio. After external expansion, the donor site of a flap or skin graft could be closed directly. The recipient and donor sites healed simultaneously. CONCLUSION: External expansion is a practical method to provide 'extra' skin for reconstruction of a large skin defect.
Adolescent↗
[Bone distraction osteogenesis].
Bone osteogenesis has been used by many surgeons to compensate dissymmetry due to congenital malformations, diseases or traumas. Bone distraction is the process of generating new bone in a gap between two bone segments in response to the application of graduated tensile stress across the bone gap. Different types of distraction are actually proposed to be an alternative to facial osteotomies or bone grafting techniques. Distraction can be unilateral, bilateral and correct the deficiencies in one, two or three dimensions. The advantages of the distraction osteogenesis are the possibilities to obtain bone lengthening together with simultaneous expansion of the functional soft tissue matrix including skin, muscles, nerves, cartilage, blood vessels and periosteum. Distractors are internal or external devices made of pins or miniplates fixed on the bone and connected by lengthening--screw--systems allowing elongation.
Adolescent↗
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↗
Finite element modeling of a progressively expanding shape memory stent.
Cardiovascular stents are small cylindrical devices introduced in stenosed arteries to reopen the lumen and restore blood flow. However, this treatment presents complications, including restenosis, which is the reclosing of the artery's diameter after the insertion of a stent. The structure of the prosthesis penetrates into and injures the walls of the patient's artery. There then follows a proliferation of cells and the formation of scar tissue around the injury, similar to the scarring of other organic tissues. This reaction to the trauma subjects the artery to close. The proposed solution is to develop a Nitinol stent with a progressive expansion device made of polyethylene, allowing smooth and gradual contact between the stent and the artery's wall by creep effect. The purpose of this paper is to describe the technology and methodology for the numerical study of this kind of stent through the finite element method. ANSYS 8.0 software is used to perform the analysis. The Nitinol is modeled with a superelastic law and the polyethylene with a yield hardening law. A first simulation determines the final geometry of the stent laser cut from a small tube. A second simulation examines the behavior of the prosthesis during surgery and over the 4 weeks following the operation. The results demonstrate that a compromise can be reached between a limited expansion prior the inflation of the expandable balloon and a significant expansion by creep of the polymer rings.
Arteries↗
Intraoral distraction for mandibular lengthening: a technical innovation.
An intraoral distraction device for mandibular lengthening is reported. Correction of vertical deficiency of the ramus was associated with expansion of the soft tissue of the jaw, without any visible scars.
Bone Lengthening↗
Corrosion Casting in the Reproduction of the Microsurface Topography of Fibrillar Collagen.
: We have used a two-step casting procedure to create replicas of fibrillar collagen. A negative replica or mold is first created using either Mercox casting resin or a prepolymerized methacrylate resin that was originally described by Murakami. In the second step, a positive replica is made from the first using a solution of polystyrene or polyurethane to coat the methacrylate cast. The resulting replica is removed from the methacrylate cast. Results indicate the highest level of spatial resolution is obtained using a modified Murakami resin for the negative cast and polystyrene for the positive replica. The 29-nm-wide repeat banding structure present on collagen fibrils could be clearly identified in both the methacrylate cast and in the polystyrene positive replica of the methacrylate cast. Thus high-resolution replicas can be obtained. Such replicas may be useful to imprint inplantable devices with biologically relevant textures to improve tissue integration or for the development of textured surfaces for the in vitro expansion of cultured cells.
Journal Article↗
Pin and screw retained palatal prostheses in cleft palate patients.
This article reviews the rationale and technical procedures for pin and screw retained palatal prostheses. These prostheses provide a useful treatment modality for cleft palate patients requiring two stage palatal repair, obturation for a large fistula, or single stage repair requiring palatal expansion in the presence of an unerupted primary dentition. Additionally, dental arch alignment can be achieved through the incorporation of an expansion screw device in the prosthesis. Post insertion problems of air and fluid leakage around the prosthesis, inflammation of the tissue underneath the prosthesis and possible damage to unerupted teeth have been observed, but are rare occurrences in properly selected cases.
Bone Screws↗
Ultrasonic bone cutting for surgically assisted rapid maxillary expansion (SARME) under local anaesthesia.
Ultrasonic bone-cutting surgery has been recently introduced as a feasible alternative to the conventional tools of cranio-maxillo-facial surgery, due to its technical characteristics of precision and safety. The device used is unique in that the cutting action occurs when the tool is employed on mineralized tissues, but stops on soft tissues. This technical note illustrates the use of Piezosurgery for all osteotomies of surgically assisted rapid maxillary expansion (SARME). The procedure, including pterygo-maxillary detachment, can be completed under local anaesthesia. Other advantages include minimal risk of jeopardizing critical anatomic structures (e.g. palatine artery), minimal intraoperative bleeding and postoperative swelling, and minimal thermal damage to bone surfaces. Narrow and rectilinear osteotomies can be easily performed with varying vibrating scalpels, at the cost of a longer operative time.
Anesthesia, Dental↗
Dental implant retrieval analyses.
The evolution of surgical implant devices has been dependent upon a multidisciplinary coordination between the basic and applied biological and physical sciences. In this regard, engineering failure analyses of retrieved prostheses represent a significant contribution. Dental implant retrieval studies have provided guidance for biomaterials, designs and biomechanical function, specialized surface treatments for controlling tissue responses, and associated surgical, periodontal, and restorative regimes. The recent expansion of design concepts and restorative procedures places a new emphasis on the need for interrelated prospective laboratory, laboratory animal, and human device investigations. Retrospective retrieval analyses continue to provide guidance with regard to key concept development and the formulation of important questions and hypotheses for future investigations.
Biocompatible Materials↗
Microwave processing of cleft palate orthopedic expansion devices.
This article describes a method for making a palatal expansion device for use in conjunction with orthopedic repositioning of the premaxilla in patients with bilateral cleft palate. The technique of constructing the devices involves the microwave processing of a permanent soft liner and a heat-cured acrylic resin in a single-stage curing cycle. The resultant expansion device has the advantages of a soft liner for retention in the nasal cavity and an oral cavity surface that is smooth and closely adapted to the tissues. A paper cover is used during the flasking process, which allows packing of materials without displacement into undesirable locations.
Acrylic Resins↗