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PubMed1993

Intraoperative tissue expansion with the Foley catheter.

BACKGROUND: As surgeons face larger and more complex surgical defects, there is the continual search for more practical, successful, and cosmetically elegant methods for repair. Intraoperative tissue expansion is a relatively new technique built upon the fundamentals of traditional chronic tissue expansion. The Foley catheter is an inexpensive, readily available device that can be used for intraoperative tissue expansion. OBJECTIVE: The purpose of this article is to explain and demonstrate some of the uses for intraoperative tissue expansion with the Foley catheter. METHODS: A series of cycles of inflation and deflation of the Foley catheter balloon allows for gradual stretching of the skin over a period of 15 to 20 minutes. RESULTS AND CONCLUSION: The "tissue gain" achieved via this technique often facilitates wound repair. The Foley catheter is a useful device and a significant addition to the dermatologic surgeon's armamentarium.

Catheterization↗

PubMed1991

Rapid intraoperative tissue expansion for closure of facial defects.

Rapid intraoperative tissue expansion (RITE) has been shown to have definite applicability to reconstruction in the head and neck. However, widespread use of this modality has yet to be adopted by the otolaryngologic community. Believing that RITE might offer some advantages in the reconstruction of soft-tissue facial defects following Mohs micrographic surgery for cutaneous malignant neoplasms, we evaluated 30 consecutive patients referred for cosmetic reconstruction after Mohs micrographic surgery for the use of RITE. Eight patients were selected and underwent reconstruction using a total of 10 tissue expanders. Herein, we describe our experience with this initial series as well as some background and future applications of RITE.

Adult↗

PubMed1986

Breast reconstruction using modified tissue expansion.

Inadequate chest-wall skin following mastectomy for carcinoma continues to be a problem in many breast reconstructions. To avoid extensive surgery, serial tissue expansion has been advocated. Since 1977, one of the authors has used a simple method of tissue expansion that we have termed "modified tissue expansion", defined as the creation of an adequate breast mound in one or two stages using a permanent prosthesis. Ninety percent of patients undergoing breast reconstruction between 1978 and 1983 were reconstructed using this method. A retrospective analysis of these 208 patients is presented. There were no mortalities, and only a 6.3 percent complication rate. Skin necroses related directly to the prosthesis occurred once, and there were no prosthetic deflations. Eighteen percent had first-step reconstruction only. The initial prosthesis averaged 400 cc in size. Selected Halsted radical mastectomy and postradiotherapy patients were successfully reconstructed. Seventy-eight percent felt their results were excellent at 1 year. Two percent were dissatisfied. Multiple office visits and the potential problems of serial expansion were avoided. Modified tissue expansion is a simple and viable method and should be considered among the options for breast reconstruction following mastectomy.

Adult↗

PubMed1997

Post-transferred tissue expansion of a musculocutaneous free flap for debulking and further reconstruction.

A free flap used for face and neck reconstruction usually results in tissue bulking and needs several debulking procedures to match the contour of the face and neck. In this paper we report an experience with a patient who underwent tissue expansion of a transplanted musculocutaneous free flap in the face for debulking of the flap and four further aesthetic reconstructions of the face and neck. The result shows that a transplanted free flap tolerates tissue expansion well. The versatile use of tissue expansion shows obvious advantages in that the transplanted flap is not only enlarged substantially by means of tissue expansion, but it is also debulked at the same time of achieve a desired thin flap for further reconstruction of the face and neck.

Burns, Electric↗

PubMed1999

Tissue expansion in the reconstruction of Tessier craniofacial clefts: a series of 17 patients.

Tessier craniofacial clefts are among the most surgically challenging examples of craniofacial dysmorphology. These clefts are characterized by hypoplasia of soft-tissue and skeletal elements throughout the three-dimensional extent of the cleft. Whereas bone grafting and craniofacial osteotomies have been successful toward correcting the underlying skeletal abnormalities, the ultimate success of these reconstructions has been limited by the deficiency of skin and soft tissue. This deficiency demands reconstruction ideally with tissue of like texture, consistency, and, especially in the face, color. Craniofacial tissue expansion was used toward reconstructing these facial clefts with like-quality tissue, allowing for tension-free reconstruction after osteotomy and bone grafting. Seventeen patients with Tessier craniofacial clefts underwent preoperative craniofacial soft-tissue expansion in the surgical management of their clefts. Tissue expansion was used in the primary correction of facial clefts in eight patients, with nine patients undergoing expansion before secondary surgery. In this series, tissue expansion has evolved as an important element in overcoming the skin and soft-tissue deficiency associated with these clefts, allowing for tension-free closure and improved aesthetic results in these surgically challenging patients.

Adolescent↗

PubMed2005

Tissue expansion in the head and neck.

Tissue expansion can be a valuable adjunct in reconstruction of large defects of the head and neck and is particularly useful in the scalp and forehead region. This article discusses the differences between conventional long-term expansion and rapid intraoperative expansion. Careful expander selection and application can allow extensive reconstructions with adjacent tissues that might otherwise be impossible. Complications are rare and usually avoidable with careful attention and technique.

Facial Injuries↗

PubMed1990

Tissue expansion in reconstruction of acquired auricular defects.

Over the past 10 years, tissue expansion has gradually become accepted as a useful adjunct to ear reconstruction with an autologous framework. The advantage of expanded tissue in these cases has been the addition of more tissue with similar color, texture, and sensation. In traumatic cases, the creation of well-vascularized tissue allows an improved anterior draping of skin over the cartilaginous framework and production of a well-defined posterior sulcus. Encroachment of hair onto the reconstructed ear is minimized because of the extra tissue produced by expansion. Under favorable conditions, tissue expansion is an acceptable and reliable method for partial or total ear reconstruction.

Adolescent↗

PubMed2003

Tissue expansion after inverted-T mammaplasty: can it be performed successfully?

Breast cancer patients will occasionally need to undergo mastectomy after previous reduction mammaplasty or mastopexy. The presence of the "inverted-T" scar presents a unique reconstructive dilemma: Do mastectomy flaps that are traversed by surgical scars still allow for adequate tissue expansion and a good aesthetic result? The objective of this study was to evaluate the authors' experience with tissue expansion/implant reconstruction in patients with an inverted-T scar. All patients who underwent tissue expansion and implant reconstruction after inverted-T mammaplasty were reviewed retrospectively to determine aesthetic results, patient satisfaction, and complication rates associated with this reconstructive technique. During a 6-year period (1995-2001), 11 patients (12 breasts) underwent breast reconstruction with tissue expansion and implant placement after either reduction mammaplasty (N = 8) or mastopexy (N = 4). All patients reached target expansion volumes. After successful tissue expansion, exchange to either saline (N = 7) or silicone (N = 5) implants was performed. The mean follow-up period after implant exchange was 18.5 months (range, 2-72 months). Complications were minimal and included partial flap necrosis (N = 1). Aesthetic appearance and symmetry were judged to be good or excellent in the majority of patients. Overall patient satisfaction was high. Tissue expansion with implant exchange is an effective reconstructive technique for mastectomy defects after previous inverted-T mammaplasty. In this series, good to excellent aesthetic results were achieved in the majority of patients with minimal associated complications.

Adult↗

PubMed2006

Tissue expansion 1984-1999: a 15-year review.

We assessed all patients who underwent tissue expansion, excluding breast reconstructions, between 1984 and 1999. A total of 237 patients had 257 expansions, normally for distorted scars, 202 of 257 cases (79%). Their mean age was 27 (range 7-67) years, most being women, 149 of 237 (63%). The mean duration of expansion was 16 weeks (range 0.4-118). The most common site was the skull (61/257). Prophylactic antibiotics were used in 224 of 257 (86%) at the time of expander insertion and 147 of 257 (56%) at the removal of the expander. Sixty-two patients (24%) had minor complications and 34 (13%) had major complications. Tissue expansion can be used with a currently acceptable failure rate though we continue to strive to lower this further.

Adolescent↗

PubMed1998

Ureteral tissue expansion for bladder augmentation.

PURPOSE: Ureteral augmentation is an effective method of bladder reconstruction using the native urothelium of a megaureter. Clinically this procedure is contingent on the presence of an enlarged ureter. We have iatrogenically produced a segmental megaureter, while preserving renal function in a pig model. The urothelium of the enlarged ureter was then used for augmentation cystoplasty. MATERIALS AND METHODS: A tissue expander suitable for insertion into the lumen of the ureter was constructed. The tissue expander was passed antegrade through a flank incision of 8 pigs, and a separate nephrostomy tube was left in place. During the ensuing 1 to 4 weeks the pigs underwent daily dilation of the tissue expander without anesthesia. After dilation the pigs underwent ureteral augmentation of the bladder. The segment of expanded ureter was isolated from the native ureter, opened and anastomosed to the bladder. The continuity of the left ureter was restored by primary ureteroureterostomy. The animals underwent cystograms at 1 and 4 weeks and were sacrificed 4 weeks after augmentation. Tissue was harvested for gross and microscopic histology. RESULTS: Of the 8 pigs starting the protocol 5 underwent successful ureteral tissue expansion followed by bladder augmentation. Tissue expansion was performed from 1 to 4 weeks, and volumes of 150 to 1,000 cc were obtained. Two to 3 weeks of dilation was optimal to achieve ease of dilation, and no animal showed evidence of discomfort or failure to thrive. All 5 animals underwent successful ureteral augmentation with primary ureteroureterostomy. Tissue expansion volumes of approximately 250 cc were optimal for tissue management and ease of augmentation. Cystograms of all augmented animals showed increased bladder capacity with filling of the ureteral segment. Histological examination of the ureteral augmentation revealed preservation and regeneration of the urothelial mucosa. CONCLUSIONS: The use of a tissue expander in the lumen of the ureter is a novel method of generating urothelium for use in bladder augmentation. It may provide an alternative to bowel in patients who require bladder augmentation. Long-term studies are currently under way.

Anastomosis, Surgical↗

PubMed1984

Cicatricial ectropion following blepharoplasty: treatment by tissue expansion.

We describe the first use of the tissue expansion principle in oculoplastic surgery. In a patient with cicatricial ectropion a specially designed tissue expander and reservoir were implanted into a subcutaneous pocket, then the reservoir was filled percutaneously with normal saline until the overlying skin was firm. Saline was injected into the reservoir weekly thereafter. Three weeks following placement the unit was removed; the cicatricial ectropion no longer existed. A week later the patient's ocular symptoms had resolved. The potential for tissue expansion in oculoplastic surgery is exciting.

Cicatrix↗

PubMed1992

The recovery of peripheral nerves following tissue expansion.

A rat sciatic nerve model has been used to study the response of nerves to tissue expansion and their recovery at intervals up to 100 days using electrophysiology and histological methods. Tissue expansion has been shown to increase nerve length by 32% of which half remained at 100 days. Following tissue expansion the mean conduction velocity of the sciatic nerve was reduced to 30.0 +/- 1.35 m/s which represented 60.3% of control values, by 100 days the conduction velocity had almost returned to normal. Histological examination showed the cause of the reduction in function to be due to segmental demyelination without axonal degeneration, these changes returned towards normal during the recovery period but were not completely reversed by 100 days.

Animals↗

PubMed1991

Chest-wall deformity after tissue expansion for breast reconstruction.

A prospective longitudinal study of chest-wall deformity after tissue expansion for breast reconstruction was performed in 19 women. CT imaging was a sensitive method for detecting occult deformity. Using a semiquantitative scale for measuring deformity, all patients and 94 percent of expanders had some thoracic abnormality after tissue expansion. Rib and chest-wall contour changes were observed under 81 and 68 percent of the expanders, respectively. Routine chest roentgenograms were not a sensitive method for evaluating these deformities. The magnitude of deformity after unilateral expansion was not significantly different from that after bilateral expansion. Linear regression analysis indicated that early periprosthetic capsular contracture was negatively correlated with chest wall deformity. Only one patient experienced a clinically noticeable complication from chest compression--transient postexpansion exertional dyspnea. After removing the expanders and placing permanent implants along with capsulotomy, the mean deformity index decreased by 57 percent after 10.5 months median follow-up, which was highly significant (p less than 0.001). Our findings suggest that chest-wall deformity is a common occurrence after tissue expansion in patients undergoing breast reconstruction and is usually of minor clinical significance.

Female↗

PubMed1993

[Treatment of skin lesions. Contribution of tissue expansion].

We report our experience of tissue expansion for removal of skin tumors in 62 patients treated between 1985 and 1991. Thirty-nine complete and 23 partial excisions were performed. Major complications with complete failure occurred in 3 percent of the cases, and minor complications in 10 percent. Skin expansion constitutes a considerable advance in the treatment of benign skin tumors as it reduces the risk of permanent scars and provides a skin that is normal in both quality and colour. In cases where the tumor cannot be entirely removed in one step (e.g. giant hairy naevus, haemolymphangioma) expansion brings quality skin within the most visible areas, enabling complete excisions by re-expansion or skin graft to be contemplated.

Adult↗

PubMed1993

Controlled tissue expansion in periocular reconstructive surgery.

BACKGROUND: Soft tissue expansion is a technique useful in reconstruction when a shortage of tissue exists. This method allows the creation of skin similar in appearance and type to that immediately adjacent to the defect. The use of this technique as a stage in repairing large periocular defects is presented. The sequence of implant placement, expansion, and ensuing eyelid reconstruction is illustrated. METHODS: The soft tissue adjacent to an eyelid defect was expanded by means of a subcutaneously implanted reservoir that was progressively inflated over several weeks by percutaneous injection of fluid. The prosthesis was removed after adequate expansion had been achieved. The expanded tissue was then used to fashion a local flap to resurface the defect. RESULTS: Upper eyelid skin expansion was performed in one patient, and five patients received expansion in an adjacent area. The expanded tissue was then used to reconstruct the eyelid defect. The only complications encountered were tissue necrosis at the tip of an advancement flap in one patient and hematoma formation within the dissection pocket after expander insertion in another patient. CONCLUSIONS: This technique complements existing reconstructive methods and provides a valuable surgical alternative for managing various periocular defects. The potential application of this technique in eyelid and periocular reconstruction appears promising.

Adolescent↗

PubMed1987

Tissue expansion. Three years' experience at Groote Schuur Hospital.

Tissue expansion for breast reconstruction and for improvement of large unsightly scars, not possible with standard local flaps, is a well-tried, effective method. Fifty-nine tissue expanders have been used in 46 patients at Groote Schuur Hospital since August 1982 for both breast reconstruction and scar revision. Expanders were placed in surgically dissected pockets and filling was performed on an outpatient basis. At a second operation the filled expanders were removed and the definitive operation performed. Complications encountered included deflation, exposure, infection, seroma and skin necrosis. Final results in most patients have been satisfactory. Tissue expansion has a wide application in reconstruction and has potential for even greater use in the future.

Adult↗

PubMed2003

[The effect of bFGF and sucralfate on cell proliferation during continuous tissue expansion].

OBJECTIVE: To investigate the effect of local application of bFGF combined with sucralfate on the cell proliferation during continuous tissue expansion (CTE). METHODS: Nine white pigs were selected to undergo the continuous tissue expansion in this study and treated with bFGF and sucralfate, respectively as the following groups: group 1 with both bFGF and sucralfate, group 2 only with bFGF, group 3 with only sucralfate, and group 4 with saline as control. Fifteen samples were taken in each pig for immunohistochemistry analysis 1-14 days and 6 weeks after the operation. RESULTS: In the group with both bFGF and sucralfate, the epidermic basal cells proliferated significantly after the operation and reached top level in 3 days, which was statistical higher than the control group, but the multiplication of basal cell was the lowest 14 days after the operation, still more than the control group. In dermal layer, proliferation of fibroblasts, vessel endothelial cells, hair follicles epidermic cells and sweat gland epicytes was also significant higher in the group with both bFGF and sucralfate than that the control group and reached top level 7 day after the operation, but the proliferation of cells decreased obviously 14 days after the operation, still higher than the control group. The mitotic activity of cells returned to the basal level in 42 days. There were no significant differences among the group 2, group 3 and group 4. CONCLUSION: Local application of both bFGF and sucralfate could be more effect to induce cells multiplication during early skin expansion to facilitate the growth of neoformed skin soft tissue.

Animals↗

PubMed1987

A hemorrhagic hazard of tissue expansion.

A case of delayed acute hemorrhage complicating tissue expansion of the scalp is presented. The likely mechanism was erosion of an occipital artery by the edge of the expander, and the risk of a similar occurrence should be considered in all patients undergoing tissue expansion.

Adolescent↗