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PubMed1992

Relative effects of intraoperative tissue expansion and undermining on wound closing tensions.

Intraoperative tissue expansion is advocated as a technique to facilitate closure of soft-tissue wounds with less tension than if they were closed primarily without expansion or, presumably, simple undermining. Few objective studies have been done, however, to validate the technique. We specifically questioned the relative effects of intraoperative tissue expansion and undermining on wound closing tensions in an animal model. Our data showed statistically significant reduction in the force required to close a wound after acute intraoperative tissue expansion when compared with baseline. However, when the degree of undermining achieved by the expander was matched in an equivalent defect, no difference in the resultant wound closing tensions could be discerned between techniques. This study should be viewed as an initial effort to understand the role of intraoperative tissue expansion in reconstructive surgery.

Animals↗

PubMed1989

Advances in burn scar reconstruction: the use of tissue expansion.

The use of tissue expansion to facilitate burn scar reconstruction is described. Twelve patients underwent burn scar reconstruction using a total of 42 expanders. Expansion was carried out at two- to three-day intervals, usually commencing as early as two to three days following insertion of the expander. In 5 of the 12 patients, previously scarred skin was expanded to facilitate excision of areas of more dense scarring and scar contractures, more conventional methods having previously failed. Two of the expanders failed to achieve adequate expansion because of exposure of the device. One of the patients in whom the expander failed refused to have it reinserted. Complications included implant exposure (9 of 42), injection port exposure (1 of 42), infection (4 of 42), and a transient facial nerve palsy in 1 patient who was having her cheeks expanded. Except for one case, implant exposure did not preclude continued expansion and ultimate reconstruction.

Adult↗

PubMed1988

Growing pains: the psychological experience of breast reconstruction with tissue expansion.

The efficacy of tissue expanders in providing additional skin and muscle for breast reconstruction has been demonstrated convincingly and repeatedly. This had led to the increasing use of this technique for certain women desiring reconstruction of the breast following mastectomy for cancer. We report on the psychological experiences of 10 women who underwent breast reconstruction by means of tissue expansion.

Adjustment Disorders↗

PubMed1995

Experimental tissue expansion induces changes in expression of procollagen I and III messenger RNA.

Experimental tissue expansion was performed in nine dogs following placement of subcutaneous silicone balloons. The balloon expander was then filled with 300 ml saline immediately after implantation. Duration of expansion varied from 3 days to 124 days. Unaffected skin and skin over an empty expander served as control tissue. Dermal procollagen I and procollagen III gene expression in response to tissue expansion was investigated by dot-blot analysis using digoxigenin-labeled RNA probes complementary to either human procollagen-alpha 1(I) mRNA or procollagen-alpha 1(III) mRNA. Cross-hybridization of human probes with canine procollagen mRNA was demonstrated by Northern blot analysis. In response to the trauma of surgery, procollagen I and III mRNA transcriptions were found to be decreased significantly within the first few days after implantation. After 9 days of expansion, increased levels of procollagen I mRNA were found, while after 16 days increased levels of procollagen III mRNA were evident. The present study is the first to demonstrate changes in dermal collagen gene expression as a reaction to tissue expansion.

Animals↗

PubMed1989

Adjunctive agents to facilitate rapid tissue expansion.

A rodent model was used to study tissue expansion. Three chemical agents--hyaluronidase, prostaglandin E2, and colchicine--were administered and their effects on tissue expansion studied. Hyaluronidase and colchicine both enhanced the rate of expansion when compared with results in control animals (p less than 0.05). Although prostaglandin E2 had less effect on expansion rate, it did significantly enhance tissue oxygen tension of expanded skin when compared with controls (p less than 0.05). Clinical implications include the possibility of pretreating patients with these agents to increase the rate of expansion and to improve the safety of current methods of expansion.

Animals↗

PubMed1995

Tissue expansion of the facial nerve in an animal model.

The usefulness of tissue expanders in reconstructive surgery has been well established for skin, muscle, and fascia. There has been only anecdotal examination of tissue expansion techniques in peripheral neural tissue. Segmental sacrifice of cranial nerves is at times required in head and neck surgery. Nerve lengthening for re-anastomosis after segmental resection would be a valuable technique. This study used tissue expansion techniques in a porcine model to explore its effects on the peripheral facial nerve. Inflation of the expander in all animals resulted in no clinical signs of neural degeneration in the lengthened nerves. Microscopy of selected facial nerve specimens demonstrated histologic changes in the neural architecture without evidence of neural degeneration by electromyography. Although there was no significant statistical difference between the experimental and control arms of this study, expansion of neural tissue warrants further investigation, potentially offering a promising adjunct in reconstructive head and neck surgery.

Animals↗

PubMed1997

The use of tissue expansion for the treatment of burn scar alopecia.

Tissue expansion is an ideal reconstructive procedure for burn scar alopecia. Donor tissue is generated in situ, allowing for the use of hair-bearing tissue to reconstruct an area of alopecia. The process of tissue expansion results in a redistribution of the remaining hair follicles to replace the area of alopecia.

Alopecia↗

PubMed1990

Rapid intraoperative tissue expansion in reconstruction of the head and neck.

A prolonged tissue expansion has the advantage of creating large amounts of additional skin for reconstructing cutaneous defects that might not be possible without the use of multiple, regional, distant, or microsurgical flaps. In spite of this, there are disadvantages, many of which can be circumvented by the use of rapid intraoperative tissue expansion instead. Although rapid expansion does not increase skin surface area as much as prolonged expansion, it may be helpful in assisting with closure of defects that might otherwise be problematic.

Face↗

PubMed1991

Treatment of tuberous breasts utilizing tissue expansion.

This article presents the tissue expansion technique for the treatment of the tuberous breast and its variant, the tubular breast. The treatment objectives are different in the two deformities, but, in general, one has to expand the base circumference of the breast, expand the skin of the lower hemisphere of the breast, release the skin tightness at the skin-areola juncture, lower the position of the inframammary fold, increase the volume of the breast skin envelope, reduce the size of the areola and correct its deformity, and perform a mastopexy when necessary. To achieve these objectives, we use a tissue expander introduced either beneath the breast or beneath the pectoral muscle through an incision along the inframammary fold. It is slowly expanded to the appropriate volume. The reconstruction is completed at the second stage when the size of the areola is reduced, the expander is exchanged for an implant, or the fill-port is removed. The tissue "herniation" is corrected and a mastopexy is performed when necessary. We treated seven tuberous breasts and three tubular breasts by the two-stage method. Eight reconstructions were completed successfully in two stages. An additional operation became necessary in two cases; one to treat an exposed expander, and another to correct a capsular contracture. The results have been uniformly good and compare favorably with those presented in the literature done by other methods. We recommend use of the combination expander/implant.

Breast↗

PubMed1990

Tissue expansion: a unit review of non-scalp, non-breast expansion.

The results in 76 tissue expansions of sites other than the breast and scalp in 56 patients are presented. The overall failure rate was 12%, being particularly high in the arm (31%) and low in the leg (0%). Details of the technique used and their relevance to success are discussed.

Adolescent↗

PubMed1995

Effects of tissue expansion on secondary ischemic tolerance in experimental free flaps.

The effects of tissue expansion on free flap tolerance and metabolic response to secondary ischemia were evaluated. A total of 178 male syngeneic Lewis rats were used: 28 in perfusion study and 75 donor and 75 recipient animals in flap survival study. Animals were organized in three experimental groups: control, sham operation, and expansion group. Sham group animals had the expander implanted but not insufflated. After 4 weeks of tissue expansion, 3 x 5-cm epigastric free flaps were transplanted to recipient animals. Twenty-four hours later, secondary ischemia was produced by 3-hour venous occlusion. Flap survival, perfusion, and enzyme activities were determined. Pre-expanded skin flaps had an increase in perfusion of approximately 700% as measured by fluorescein levels compared with control flaps (p < 0.001) and demonstrated a better success rate (76%) compared with those of the control (40%) (p < 0.05) and sham (28%) groups (p < 0.05). Glutathione peroxidase, glutathione reductase, and glucose 6-phosphate dehydrogenase of the antioxidant defense systems significantly increased in skin in both the sham and the expansion groups. In response to secondary ischemia, the control and sham groups exhibited a decrease in enzyme activities of the glutathione redox cycle, whereas the expansion group showed no significant changes from the elevated baseline activities. Tissue expansion improved flap tolerance to secondary ischemia by increasing flap circulation and probably by augmenting tissue metabolic response to oxidative stress.

Animals↗

PubMed1990

The role of tissue expansion in the treatment of atypical facial clefting.

Tissue expansion can be a valuable tool in the reconstruction of soft-tissue defects in craniofacial clefts. To our knowledge, there have been no reports in the literature of the use of tissue expanders to help solve this problem. We report the case of a child with an atypical Tessier no. 3 craniofacial cleft who had a forehead tissue expander placed, inflated, and thus used to provide sufficient local facial skin for repair of the soft-tissue defect.

Cleft Lip↗

PubMed2000

Co-Ordination of Cell Division and Tissue Expansion in Sunflower, Tobacco, and Pea Leaves: Dependence or Independence of Both Processes?

Temporal analyses of cell division and tissue expansion in pea, tobacco, and sunflower leaves reveal that both processes follow similar patterns during leaf development. Relative cell division and relative tissue expansion rates are maximal and constant during early leaf development, but they decline later. In contrast, relative cell expansion rate follows a bell-shaped curve during leaf growth. Cell division and tissue expansion have common responses to temperature, intercepted radiation, and water deficit. As a consequence, final leaf area and cell number remain highly correlated throughout a large range of environmental conditions for these different plant species, indicating that cell division and tissue expansion are co-ordinated during leaf development. This co-ordination between processes has long been explained by dependence between both processes. Most studies on dicotyledonous leaf development indicate that leaf expansion rate depends on the number of cells in the leaf. We tested this hypothesis with a large range of environmental conditions and different plant species. Accordingly, we found a strong correlation between both absolute leaf expansion rate and leaf cell number. However, we showed that this relationship is not necessarily causal because it can be simulated by the hypothesis of independence between cell division and tissue expansion according to Green's theory of growth (1976).

Journal Article↗

PubMed1990

Intraoperative tissue expansion using a Foley catheter following excision of a basal cell carcinoma.

Chronic tissue expansion has gained an accepted role in reconstructive surgery. Recently, intraoperative tissue expansion (rapid expansion) has been introduced as an alternate technique for recruitment of additional tissue to aid in wound closure. At the present time, the available expanders are designed for single use and then must be discarded; thus they are relatively expensive. We present the use of the readily accessible Foley catheter as a suitable, inexpensive, safe, and practical device for intraoperative tissue expansion.

Basal Cell Carcinoma↗

PubMed2000

[Application of skin and soft tissue expansion in treatment of burn injury].

OBJECTIVE: To evaluate the application of skin and soft tissue expansion in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound. METHODS: From 1988, 83 cases of application of skin and soft tissue expansion were reported. In those patients with deformity due to severe burn of large area and with whole nasal defect, soft tissue expander was used under the forehead skin graft and venter frontalis, followed by reconstruction of nose with the expanded vascularized skin flap and carved cartilago costalis as nasal frame. In patients of severe deep electrical burned scalp and skull with fresh wound, skin and soft tissue expansion were used to repair the wound simultaneously with scalp burn alopecia, anesthetics and antibiotics injected into the extracapsular space of the expander in case of pain and infection. RESULTS: All of the cases were successfully treated with little pain and minimized infection. CONCLUSION: Skin and soft tissue expansion in a safe and reliable measure in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound.

Adolescent↗

PubMed2002

[Overlapping tissue expansion techniques and its clinical applications].

OBJECTIVE: To improve the results of the soft tissue expansion technique. METHODS: Two expanders were buried in the same soft tissue pocket in an overlapping pattern. The inflation process was carried out routinely. RESULTS: 19 cases of various tissue defects were treated with the overlapping tissue expansion technique since March 1999. Good results have been achieved. CONCLUSION: The overlapping tissue expansion technique can provide much more expanded tissue and reduce complications compared with the traditional expansion technique. It is especially suitable for repair of the defects at the facial and cervical region.

Adolescent↗

PubMed1992

Postburn breast reconstruction: tissue expansion prior to contracture release.

Tissue expansion of the scarred chest following burns results in a poor breast mound shape with little projection or inframammary fold, since the expander, like normal developing breast tissue, is kept flat by the scarred skin envelope. We present a case that demonstrates that adequate projection of the breast and formation of an inframammary fold can be achieved by expansion if extensive release and skin grafting of contractures over the breast mound are performed after expansion. Maintained expansion will act as a stent reducing secondary contracture of the grafted-areas.

Adult↗

PubMed2000

The use of serial tissue expansion in pediatric plastic surgery.

There are clinical situations in which even despite the use of simultaneous multiple tissue expanders, complete coverage of a defect cannot be achieved. In this situation, serial, repeated tissue expansion may be indicated. There are few studies that have reported repeated tissue expansion in pediatric plastic surgery. Twelve children (6 girls, 6 boys) with a mean age of 7 years underwent serial tissue expansion for giant hairy nevus (N = 3) or burn reconstruction (N = 9). A total of 63 tissue expanders were used. Serial expansion of the expanded flap was performed a second time in 12 children, a third time in 6 children, and a fourth time in 2 children. The major complication rate was 4% for the first expansion, and 20%, 18%, and 0% for the second, third, and fourth expansions respectively. Clinically, at the time of expander reinsertion, there was no evidence of capsule from the previous expander in any patient. This was confirmed on histological examination of 12 biopsy specimens. Repeated tissue expansion is a safe and effective procedure for use in pediatric plastic surgery.

Burns↗