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PubMed1988

Rapid tissue expansion in the treatment of myelomeningocele.

In 2 patients undergoing spinal fusion for correction of kyphoscoliosis secondary to myelomeningocele skin coverage was achieved with rapid tissue expansion. Tissue necrosis caused by overly rapid expansion in the first patient was prevented by rapid, but more controlled, expansion in the second patient. Rapid tissue expansion in the paraplegic in a carefully controlled setting is useful and can be done without unduly prolonging hospitalization. This technique has potential uses in other clinical situations as well.

Adolescent↗
PubMed2004

The beginning of a new era in tissue expansion: self-filling osmotic tissue expander--four-year clinical experience.

The osmotic tissue expander is a new device made of a hydrogel expanding skin that does not require external fillings. Once implanted, it absorbs body fluids, which leads to a gradual swelling of the device. The swelling phase is completed in 6 to 8 weeks and results in skin gain. Different shapes and sizes are available, and the devices can be used in almost every area of the body. Over a 4-year period, the osmotic tissue expander was used in 58 patients in different areas of the body. A round osmotic tissue expander was mainly used in breast reconstruction, and a rectangular expander was used for defect coverage after excision (i.e., of scars and tumors). The mean age of the patients was 49.34 years (range, 4 to 76 years). During the expansion phase, the patients noted only a little discomfort and pain for the first few days. Without a silicone membrane in the first-generation expander, the rate of successful explantation and good final result was 81.5 percent. In a few cases, rapid swelling of the device led to the introduction of a silicone membrane that encloses the expander and leads to a slower, more gradual, and consistent swelling. After introduction of the silicone envelope, the success rate improved to 91 percent. The expander is now used with a silicone membrane in every case. The osmotic tissue expander has many advantages compared with the conventional expander: there is no need for painful external fillings and the risk of external infections is avoided. The expander is 10 percent of its final volume and only requires a short incision and a small pocket. An operation can easily be performed under local anesthesia, with minimal tissue mobilization in older children and compliant patients.

Adolescent↗
PubMed1993

An animal model for subperiosteal tissue expansion.

An animal model for subperiosteal tissue expansion is described. Small tissue expanders were placed bilaterally and inflated in the buccal subperiosteal pockets of the mandible. Additionally, subcutaneous expansion was performed in the breast region. Twenty-one dogs were used in three experimental groups to evaluate the optimal size of an expander for this model, the optimal inflation regimen, and the histologic changes following subperiosteal expansion. Hemicylindrical expanders, 20 mm in width, 10 mm in height, and 30 mm in length, inflated with 1 mL saline every four days, were used for this model. It was found that the periosteum was replaced by fibrous connective tissue during expansion. Capsule formation following subperiosteal expansion was much more rapid than that following subcutaneous expansion. A greater increase in vascularity was noted in the subperiosteal expansion group and the subperiosteal control group than in the subcutaneous expansion group. In the subperiosteal expansion group, a thick fibrous capsule, with minimal inflammatory response, was observed 1 week after full inflation. Leaving the fully inflated subperiosteal expanders in place more than 1 month accelerated the resorption of the underlying bone. These results support the previously reported empirical regimens of subperiosteal tissue expansion. Furthermore, the excellence of the subperiosteal expanded bed as a recipient site for onlay grafting was confirmed.

Alveolar Ridge Augmentation↗
PubMed1997

Tissue expansion in the upper extremities.

In this article, the authors demonstrate current concepts of soft-tissue reconstruction using tissue expansion principles. History, pathophysiology, and biomechanics of tissue expansion are reviewed. Anatomic areas of expander use in the upper extremity have been delineated, as well as new concepts of nerve and arterial elongation using intraoperative expansion techniques. The authors outline their current technique of upper extremity tissue expansion in the preoperative, intraoperative, and postoperative settings, allowing the reader to appreciate the technique of tissue expansion and its role in soft-tissue reconstruction of the upper extremity.

Adult↗
PubMed1988

Tissue expansion for the reconstruction of burn defects.

Tissue expansion has emerged recently as an alternative reconstructive procedure and has been used for the treatment of a variety of defects. This paper presents our experience with the use of tissue expansion exclusively for the treatment of secondary burn defects. The technique was used in 22 consecutive patients. The technical aspects of the procedure are described. The advantages of tissue expansion, including the superior quality of reconstruction, cost effectiveness, and absence of donor site scar are presented. The disadvantages, including the need for two stages, multiple office visits, its application for relatively small defects, and the objectionable temporary appearance, are discussed. Finally, patient selection, and refinements of the technique and tailoring of the expanded flaps to achieve the best possible reconstructive and esthetic results and limit the possibility of complications are discussed.

Adolescent↗
PubMed1990

Tissue expansion of the head and neck. Indications, technique, and complications.

Tissue expansion is indicated in the reconstruction of various defects of the head and neck in instances where there is inadequate adjacent tissue to allow either primary closure of the defect or repair with a local flap. It may also be indicated in instances where repair of a defect by an alternative method such as a local, regional, or distant flap will result in an unacceptable donor or recipient site deformity. Although tissue expansion is simplistic in concept, it does require judgment and indepth preoperative planning to ensure optimal results. The complication rate is high for tissue expansion in the head and neck, particularly in the cheek and neck area. Despite the frequency of complications, in the vast majority of cases the intended reconstruction is successful.

Dermatologic Surgical Procedures↗
PubMed1993

The effect of tissue expansion on the random flap viability and wound tensile strength of previously irradiated rabbit skin.

Tissue expansion facilitates coverage of cutaneous defects both through the generation of additional skin surface area and by increasing random flap length/width viability factors. The opportunity to apply tissue expansion techniques to head and neck defects within previously irradiated skin fields continues to increase. To study the effect of tissue expansion on the cutaneous perfusion and wound-healing capacity of irradiation-damaged skin, rabbit scalps were subjected to 5 weeks of fractionated radiation followed at 4 months by prolonged tissue expansion. Standardized random flaps were then created and reset within the expanded skin and analyzed in parallel with nonirradiated and nonexpanded control animals. Flap viability as expressed by area and mean maximum length was determined at 10 days postwounding followed by determination of wound-breaking strength. Irradiated tissues demonstrated a significantly reduced flap viability that was significantly increased by expansion. However, tissue expansion-related increases in flap length exceeded those expressed as percent of total area surviving for irradiated animals. Tissue expansion resulted in significant increases in wound tensile strength only in nonirradiated animals. These findings suggest that, compared with controls, several of the benefits of tissue expansion are less appreciable in radiation-damaged skin.

Analysis of Variance↗
PubMed1997

Three-dimensional morphometric analysis of the effects of subperiosteal palatal soft-tissue expansion in growing cats.

A prospective longitudinal study in 75 growing cats was conducted to evaluate palatal soft-tissue expansion in cleft lip and palate surgery. In 31 cats, palatal scars were induced by simulated Langenbeck surgery at the age of 8 weeks. At the age of 14 weeks, custom-made tissue expanders were inserted 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 expander). The effects of the experimental interventions were evaluated on a series of dental casts during the inflation period and until 8 weeks after removal of the tissue expander. The results indicate that soft-tissue expansion of the palatal mucoperiosteum is feasible. Until 20 weeks of age, no differences were found between both expansion and sham groups. Thereafter, significant soft-tissue surface-area gain was quantified in relation to the base surface and base diameter of the tissue expander. Iatrogenic side-effects of active tissue expansion consisted of significant transversal growth retardation in the anterior part of the bony palate and dentoalveolar structures. After removal of the tissue expanders, some accelerated growth in the tissue-expansion, scarred-tissue group was seen. It is concluded that palatal soft-tissue expansion is possible in growing cats, with and without the presence of palatal scars; however, this technique, like other kinds of palatal surgery, impairs dentomaxillary growth and development.

Age Factors↗
PubMed1997

[Local administration of drug during tissue expansion].

In order to shorten the expansion time and reduce complications in tissue expansion, we developed a new method using local delivery of drug during tissue expansion. The procedure commenced with placing an implant syringe between the skin and the expander. While the skin was expanded, the drugs such as prednisolone and procaine were injected under the skin from the implant syringe. We have used the method in 23 cases and compared the results with the control group of 11 cases. It was found that the new method shortened the expansion time and reduced complications. The method had definite effect and the manipulation was simple and convenient. We conclude that the method is of value to assist tissue expansion and is worth employing routinely.

Adolescent↗
PubMed1993

Assessment of survival and microscopic changes in porcine skin flaps undergoing immediate intraoperative tissue expansion.

The technique of rapid intraoperative tissue expansion has been used with increasing frequency in the clinical setting over the last several years. This technique takes advantage of the skin's ability to immediately stretch and increase in surface area when expanded under a constant load. Sixteen random-pattern, rapidly expanded skin flaps on 10 domestic male pigs were studied to assess the predictive value of the fluorescein test for flap viability after rapid intraoperative tissue expansion. Partial fluorescence was found to be a more accurate predictor of flap survival in the experimental rapidly expanded flaps when compared to full fluorescence. Partial fluorescence was found to under-predict flap survival by 0.3 to 0.5 cm, whereas full fluorescence was found to under-predict flap survival by 2.5 cm. Additionally, histologic and ultrastructural changes were examined in rapidly expanded skin from the hip region in three pigs. The only microscopic change noted between control and experimental flaps was dilated capillaries in the dermis of expanded skin, which was noted by electron microscopy. Collagen and elastic tissue changes were not demonstrated in rapidly expanded pig skin by electron microscopy, direct immunofluorescence, collagen, and elastic tissue stains.

Animals↗
PubMed1992

Breast reconstruction using tissue expansion.

To assess the advantages of tissue expansion as a method of breast reconstruction, a prospective, consecutive study was carried out in 41 women who had undergone mastectomy. The expander was positioned in the submuscular plane and expanded weekly to double the volume of the calculated permanent implant. A permanent gel implant was inserted after 10 weeks. Two examiners judged the rate of capsular contracture after 15 and 32 months according to the Breast Augmentation Classification. The rate of capsular contracture was 28% at the second follow-up. Major complications were rare--7%. The patients were pleased with the overall result in 82% of cases. We conclude that tissue expansion is safe, produces a good result and causes few complications with only minor discomfort to the patient.

Adult↗
PubMed2004

Accelerating tissue expansion by application of topical papaverine cream.

The rate of tissue expansion can be accelerated by papaverine through a special delivery system, according to an early report. Because the delivery system was complex and inconvenient, another means of administrating papaverine was tested to observe the rate of tissue expansion. In this study, 24 miniature pigs were divided equally into three groups. Four 150-ml silicone expanders were implanted into each pig in groups A and C. Four modified rectangular silicone expanders were also implanted into each animal in group B. During the expansion process, 1 g of 2% hydrochloride papaverine cream was applied topically onto the surface of each pig's expanding skin in group A two times daily, and hydrochloride papaverine solution was injected into the outer shell of each modified expander in group B weekly. Group C acted as the control group. The mean sum of the first four times of saline water volume that was injected into the expanders was 142.42 +/- 5.6 ml in group A, 128.72+/-4.8 ml in group B, and 106.38+/-3.28 in group C. There were statistical differences among the three groups. The mean sum of volume saline water that was injected into hind expanders was 137.51 +/- 5.1 ml in group A, 120.35 +/- 3.6 ml in group B, and 102.63 +/- 4.76 ml in group C, and there was a statistical difference among the three groups as well. There was no statistically significant difference in the thickness of fibrous capsules among the three groups. This study shows that the rate of tissue expansion can be accelerated by topical application of papaverine cream, and the rate is better than the rate of tissue expansion induced by the special drug delivery system.

Administration, Topical↗
PubMed2000

Tissue expansion: a promising trend for reconstruction in urology.

To evaluate the role of the tissue expansion concept in reconstructive urology, the contemporary literature was reviewed, together with our own results with tissue expansion. The principle of tissue expansion has been applied in cases of bladder augmentation, ureteral dilation for the generation of indigenous tissue and subsequent ureterocystoplasties, ureteral elongation, and dilation of the renal pelvis, producing native tissue for the reconstruction of defects or strictures of the upper ureter. Even though the exact mechanism of action of mechanical strain in different tissues is not known, tissue expansion is a well-accepted technique that can amplify the armamentarium of reconstructive urologists for the management of defects along the urinary tract.

Humans↗
PubMed1987

Tissue expansion reconstruction of soft tissue avulsions of the face: report of two cases.

A technique utilized to increase the amount of skin available for repair of soft tissue defects with local flaps has been described. Indications for the use of tissue espansion and the surgical technique and possible disadvantages have been discussed. Two case reports are presented to illustrate the use of the tissue expander to repair avulsive craniofacial defects.

Adult↗
PubMed2004

External tissue expansion successfully achieved using negative pressure.

The practice of internal tissue expansion by implanting a silicone balloon into the soft tissue under the skin is now known to be associated with a significant risk of complications. Therefore, we designed and developed a new technique of mechanical external tissue expansion achieved by using negative pressure created through special valved cups. The subjects were 60 patients suffering from postburn scar contractures in different parts of their bodies. A valved cup was applied to the healthy skin on both sides of the scar and negative pressure of -100 to -200 mbar was connected to the cup through a special valve for 5 h out of every 12 h for 2-3 weeks preoperatively. During the subsequent operation, the scar was excised, and then the expanded skin was dissected followed by wound closure. We were able to excise the scars and close the wounds directly in 14 patients, but needed to perform Z-plasty in the other 46 patients. Some ecchymosis appeared on the skin at the site of application of the cup in the initial stages, when the negative pressure exceeded the upper limits of -100 to -200 mbar. The clinical application of external tissue expansion achieved by creating negative pressure shows great promise.

Adolescent↗
PubMed1996

[Clinical application of repeated tissue expansion].

Since 1992, the technique of repeated tissue expansion has been used to repair defects from resection of burn scars. Ten patients were treated with this technique and obtained satisfactory results. The clinical application demonstrated that a new expander could be placed again at the time of the expanded flap advancement for repeated expansion. The operative procedure, advantages, indications and key points were discussed. We concluded that repeated tissue expansion is an effective technique for the repair of large skin defects.

Adult↗
PubMed1993

Comparison of rapid versus slow tissue expansion on skin-flap viability.

The effect of rapid versus slow tissue expansion on random-pattern skin-flap survival lengths was evaluated in two groups of pigs. Each group (group 1--slow; group 2--rapid) was further evaluated for the effect that delay (A), delay plus expansion (B), expansion only (C), and acute flap elevation (D) had on flap length viability. Intergroup and intragroup comparisons were made. In the slowly expanded group, significantly greater flap length viabilities were demonstrated in the slow expansion flaps as compared with the delay plus expander flaps and the delayed flaps, respectively. In the rapidly expanded group, the flap length viabilities of flaps C, B, and A were statistically equal. However, the flap length viability of the rapidly expanded flaps was statistically equal to that of the slowly expanded flaps (C1 = C2). The effect tissue expansion has on improving flap length viability as compared with the delay phenomenon may be related to the combination of a delay effect plus increased nutrient flow density that slow expansion produces. This combined metabolic enhancement is preserved with rapid tissue expansion.

Animals↗
PubMed2000

[Analyzing study of complications of tissue expansion related to the injectable system].

OBJECTIVE: To analyze the complications of tissue expansion related to its injectable system. METHODS: One hundred and ninety six patients were followed up and analyzed for the complications of the tissue expansion concerned to its injectable system. The management of these complications was also reviewed. RESULTS: There were five kinds of the complications(with the occurrence of 32%) related to the injectable system in this group patients. The highest frequency of the complications occurred in the implantation stage. Further management was also documented well. CONCLUSION: The complications of tissue expansion related to the injectable system occurred commonly and should be paid more attention on them.

Adolescent↗