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PubMed1993

Primary reconstruction of congenital facial lesion defects with tissue expansion.

BACKGROUND: Congenital facial lesions may require surgical intervention to correct deformity or to decrease the potential for malignant degeneration. OBJECTIVE: Hemangiomata and melanocytic and sebaceous nevi are among the most common congenital facial defects. The techniques and outcome of serial tissue expansion in the management of facial lesions were evaluated. METHODS: Seven pediatric patients had congenital facial defects treated with tissue expansion and subsequent excision and reconstruction. RESULTS: All patients had a satisfactory outcome. Complications are reviewed, and in this patient population were minor. CONCLUSIONS: Tissue expansion has a role in surgical management of congenital facial lesions. Staged excision, skin grafting and nonintervention are also options which must be individualized to the case at hand.

Child↗
PubMed1984

Controlled tissue expansion in reconstructive surgery.

Controlled soft tissue expansion by encouraging the development of tissues which are ideally matched in colour, texture and hair-bearing qualities to a given donor defect, offers a new, safe and widely applicable technique in reconstructive surgery. Over the past four years we have used this technique to reconstruct "difficult" defects in many parts of the body. When necessary, synthetic implants or bone grafts have been successfully implanted beneath the expanded tissues.

Adult↗
PubMed1995

Is soft tissue expansion in lower limb reconstruction a legitimate option?

From 1986 to 1994, a consecutive series of 34 patients had 37 expanders placed in their legs. Indications for expansion included removal of painful ro unstable scars, chronic post-traumatic ulcers and one benign skin lesion. In 13 patients the lesion or scar was greater than 5 cm in diameter. The area of expansion was mainly in the proximal and distal thirds of the lower limb. On three occasions two expanders were simultaneously used in the same patient. The treatment with this technique was ultimately successful in 23 patients (67.6%) but 15 of the 23 patients (44% of the 34 patients) had minor wound healing problems. Before 1990, technical complications such as leaking injection ports caused further small interventions in 6 patients without compromising the ultimate outcome. The goal was not achieved with the expansion technique in 11 patients (32%). 5 of these 11 patients could be treated successfully with another surgical modality. All 34 patients were re-evaluated with an average follow-up of 4.5 years. We conclude that tissue expansion is ideal for removal of localised areas of scar, repair of contour defects and excision of benign tumours. Contraindications of soft tissue expansion are, in general, extensive scarred areas with compromised blood supply after trauma, vascular disease and osteomyelitis. These conditions require reconstruction with well vascularised tissue such as muscle flaps. A compliant patient is essential for lower limb reconstruction with tissue expansion. In spite of the tempting simple method of tissue expansion, success in the lower limb depends not only on the indication but also on the operating technique of the plastic surgeon.

Adolescent↗
PubMed2005

[Repair of large cicatricial alopecia with skin soft-tissue expansion].

OBJECTIVE: To investigate the clinical application of skin soft-tissue expansion in repairing large cicatricial alopecia. METHODS: From January 1989 to December 2003, 38 cases of large cicatricial alopecia were repaired by expanding scalp. The scalp was expanded, the cicatrix area was resected and the mode of propulsive or rotary flap was adopted. The size of alopecia ranged from 15 cm x 7 cm to 23 cm x 15 cm. RESULTS: The cicatricial alopecia in all the 38 cases was repaired and the hair growth was excellent during 1-2 year follow-up. CONCLUSION: The soft-tissue expansion technique is the initiative choice and an efficient method for repairing large cicatricial alopecia.

Adolescent↗
PubMed1989

Biochemical, biomechanical, and physical changes in the skin in an experimental animal model of therapeutic tissue expansion.

Biochemical, biomechanical, and physical changes occurring in the skin during tissue expansion have been studied using an animal model in which a Silastic expander was inserted into the peritoneal cavity. Forty-eight Sprague-Dawley rats were divided into four groups to be studied at 4, 8, 16 and 32 days after expansion. In the experimental animals (6 per group) the expander was inflated by a single injection of 120 ml of saline. Sixteen hours prior to sacrifice each animal received a single injection of tritiated proline. Sixteen days after expansion both the specific activity and the total content of hydroxyproline in the skin were significantly elevated in experimental animals. Intrinsic skin tension increased dramatically at the time of inflation but fell almost to control values at the end of 32 days. Skin thickness, initially decreased, returned to normal by the end of the experiment. There were no significant differences in breaking strengths between skin from experimental and control animals. Skin surface area, initially increased by stretching at the time of inflation, increased further between Days 0 and 8, possibly as a result of stress relaxation combined with enhanced remodelling of connective tissue macromolecules, and again from Days 24 to 32. We conclude that, during tissue expansion, there is a net accumulation of collagen in the skin and that this allows the local cellular environment to return to normal with respect to pressure and/or tension.

Animals↗
PubMed1996

[Surgical treatment of superficial vascular malformations. Indications for tissue expansion].

The aim of this work was to demonstrate the feasibility of surgical exeresis of superficial vascular malformations using tissue expansion. A retrospective analysis of data from 15 patients who underwent surgery over a 9 year period for arteriovenous (n = 6) and venous malformations of the trunk and limbs was made. Indications for treatment were pain in six patients or complications of an arteriovenous malformation. Twenty-eight expanders were used in 15 patients. Most of the complications observed (25% of the cases) were minor. The program had to be interrupted due to complications in only one case (7%). Mean duration of tissue expansion was 105 days (30-165). Mean delay to cicatrization was 40 days and mean duration of the treatment program was 156 days. Indication for surgical exeresis of superficial vascular malformations can be widened due the contribution of tissue expansion. With acquired experience, the risk of complications has been reduced. The duration of the treatment protocol is the main drawback.

Adolescent↗
PubMed2006

[Prevention and treatment of postoperative complications after skin soft tissue expansion for scar alopecia].

OBJECTIVE: To summarize the prevention and treatment of postoperative complications after the skin soft tissue expansion for scar alopecia. METHODS: From January 1995 to June 2005, 57 patients with scar alopecia were admitted to our department for treatment. Of the patients, 25 were males and 32 were females with their ages ranging from 5 to 55 years. The causes were burn in 33 patients, trauma in 14, alopecia after head surgery in 8, and other causes in 2. Their disease courses ranged from 6 months to 15 years. For treatment, 89 therapeutic expanders were utilized in 57 patients. The retrospective analysis on the complications and their prevention and treatment were performed. RESULTS: The follow-up for 3-12 months averaged 6 months revealed that 81 areas undergoing the expander insertion healed well and the hair grew well, too. Eight areas undergoing the expander insertions had complications, including expander exposure in 2 patients, infection in 2, hematoma in 1, expander rupture in 1, necrosis of the flap tip in I, and scar necrosis at the injection port in 1. The results also revealed that there was a significantly increased rate of complications in the patients aged 5-10 years and the patients older than 50 years (P<0. 05). The complication rate in the patients who received 2 expanders at one time was significantly higher than that in the patients who received only 1 expander (P<0. 05). However, there was no significant difference in the complication rate in the other kinds of patients. All the complications were effectively treated with a satisfactory therapeutic result. CONCLUSION: The skin soft tissue expansion for scar alopecia can effectively prevent and treat postoperative complications. If the complications are identified early and treated properly, the therapeutic results will be satisfactory.

Adolescent↗
PubMed1998

Tissue expansion of a tube flap during the last transferring stage in reconstructions of the face and neck.

The tube flap technique is an old and safe distant flap for soft tissue reconstruction, and tissue expansion is a well known way of repairing adjacent soft tissue defects. We have experience of expanding a tube flap during the last transferring stage for reconstruction of the face and neck after a burn. The tube flap from the right acromiopectoral region, of which the two pedicled stumps had been transferred to the face and neck separately, was successfully extended to double its length in 17 days without changing the diameter of the flap by placing a tissue expander under the tube flap. The tube flap tolerates tissue expansion well, even after the pedicles of the flap have been transplanted to new positions. In this way, a tube flap can be enlarged by tissue expansion when it is used in certain cases of reconstruction.

Adolescent↗
PubMed1982

Histomorphologic evaluation of guinea pig skin and soft tissue after controlled tissue expansion.

To evaluate the histologic changes attendant on tissue expansion in the guinea pig, self-inflating implants were placed in the dorsal subcutaneous space and the tissue response was sequentially studied at periods ranging from 1 to 18 weeks. Fixation artifacts have been minimized. The cellular response is relatively benign. The epidermis does not undergo thinning during expansion, although dermis and panniculus carnosus become significantly thinner. Atrophy of panniculus muscle is demonstrable. This study supports the hypothesis that tissue expansion results in a net gain of donor tissue.

Animals↗
PubMed2002

[Computer-aided tissue expansion 3D profilometry and surgery planning system].

OBJECTIVE: To develop and evaluate the computer-aided system in measurement of expanded skin and preoperative planning. METHODS: Stereophotogrammetric technique was used to gain the 3D image-pairs, from which the contours of the expanded sites were restored. The 3D surface data were provided to the specially developed "computer-aided tissue expansion 3D profilometry and surgery planning system", to calculate the expansion area and help the preoperative design. RESULTS: The system has been applied clinically in 16 tissue expansion sites of 11 patients with fairly good results since March 1999. Compared with the traditional method, this system is accurate, repeatable and feasible. CONCLUSION: This technique is useful and promising for improving the operation of tissue expansion.

Adult↗
PubMed1997

The effects of tissue expansion on the hemodynamic and survival characteristics of reverse-flow island flaps: an experimental study in rabbits.

The effects of tissue expansion on the hemodynamic and survival characteristics of reverse-flow island skin flaps were investigated in New Zealand White rabbits. The animals were divided into 3 groups of 15: group I (control) had no surgery prior to flap elevation, group II (nonexpansion) had a noninflated expander, and group III (expansion) had an inflated expander of 80 ml. After 3 weeks of expansion, a reverse-flow island flap based on the distal saphenous pedicle was elevated. A series of hemodynamic studies was performed to test reverse venous flow--in particular, valve competence. Besides observing the reverse flow under an operating microscope, the changes in the intravenous pressure were measured at 0, 5, 15, 30, 60, and 120 minutes after flap elevation. Moreover, reverse-flow resistance (RFR) was measured in each group to test the competence of venous valves. At each time interval, the values of intravenous pressure were significantly lower (p < 0.01) in group III than in the groups I and II. However there was no statistically significant difference between group I and group II. The RFR was measured as 126.7 +/- 33.52 mmHg in group I, 59.3 +/- 29.86 mmHg in group II (p < 0.01), and 25.1 +/- 7.68 mmHg in group III (p < 0.01). Ten days after flap elevation the mean survival of group III (100%) was statistically higher than that of group I (57.4 +/- 18.3%; p < 0.01) and group II (81.6 +/- 12.8%; p < 0.05). These findings simply suggest that controlled tissue expansion improves retrograde venous drainage and increases the survival of reverse-flow island flaps in rabbits. Abnormal dilatation of the venous tree and incompetence of the venous valves seem to be the main factors in explaining the decrease in the values of RFR and intravenous pressure in the expanded flaps. The potential mechanisms to explain the effects of tissue expansion, and the clinical implications are discussed.

Animals↗
PubMed1997

Tissue expansion as an adjunct to reconstruction of congenital and acquired auricular deformities.

The role of tissue expansion in ear reconstruction has not been clearly defined. Tissue expansion was used to reconstruct 16 ears for posttraumatic, burn and congenital defects. Previous surgery or scarring in the region of the reconstruction was not regarded as an absolute contraindication. The overall complication rate was 31.2%. According to the senior author's grading system, the contours were excellent in 4 ears, good in 9 ears and fair in 3 ears.

Adolescent↗
PubMed2001

[Clinical study of a new expander with an agent delivery system and the effect of a chemical agent on tissue expansion].

OBJECTIVE: To search for a method to enhance tissue expansion. METHOD: A new type of expander with an agent delivery system was used to expand soft tissue in 15 patients. During expansion Papaverine was delivered through the delivery system into the tissue around the expanders. RESULTS: It took 26 days to expand to the anticipated volume in the new expansion method group (NEM) and 51 days in the general expansion method group (GEM) (P < 0.01). Before operation the NEM group was over-expanded by 92.4% while the GEM group was over-expanded by 27.12%. At full expansion the blood flow of the expanded area of the two groups was 1.27 (NEM) and 0.64 (GEM). The immediate skin retraction of the two groups was 20.17% (NEM) and 38.26% (GEM). CONCLUSION: The new expansion method can accelerate expansion speed and improve the quality of expanded skin and flap.

Drug Delivery Systems↗
PubMed2002

Tissue expansion in the limbs: a comparative analysis of limb and non-limb sites.

We present an 8 year retrospective case-note study of 88 patients, who underwent 113 episodes of tissue expansion for a variety of indications. Overall, 31 patients underwent 42 episodes of tissue expansion in the limbs, and 57 patients underwent 71 expansions at other sites. Although the incidence of complications was higher in the limb group (43%) than in the group undergoing expansion at other sites (27%), the overall success in completing expansion was remarkably similar in both groups (86% and 83%, respectively). The indications and contraindications for tissue expansion in our cases are presented, as is the specific management in the presence of infection or exposure. Careful case selection, proper planning and meticulous surgical technique are important in minimising complication rates and ensuring both success and salvage in the case of any mishaps.

Adolescent↗
PubMed1991

Loss of factor XIIIa in pig dermis during tissue expansion.

Considerable evidence suggests that factor XIIIa, a blood coagulation factor, also functions in tissue repair, and specifically in the dynamic process of fibroplasia. On the other hand, the dynamic process of tissue expansion would require a loosening of the dermis, the opposite of fibroplasia. We examined the effects of tissue expansion on the expression of factor XIIIa in pig skin. Standard immunohistochemical procedures were used coupled with a rabbit antibody to factor XIIIa. In this report, we demonstrate that the normal expression of factor XIIIa in pig dermis is completely inhibited at the apex overlying the tissue expander. Factor XIIIa inhibition during expansion supports the thesis that this substance is important in the production and maintenance of fibroplasia.

Animals↗
PubMed1996

Soft tissue expansion prior to arthroplasty in the multiply-operated knee. A new method of preventing catastrophic skin problems.

Ten knees in nine patients underwent gradual soft tissue expansion prior to major knee surgery. All patients had multiple prior operative procedures around the knee. The resultant multiple skin incisions were felt to potentially jeopardize the postoperative status of the soft tissues. Each knee underwent the surgical placement of a tissue expander through a bed of adjacent healthy soft tissue followed by the gradual inflation of the expander over an average of 64.5 days. The average volume of soft tissue expansion was 313.7 mL per knee. Subsequent major knee surgery requiring an arthrotomy was performed at the time of expander removal followed by uncomplicated soft tissue closure. All wounds healed without any complications.

Adult↗
PubMed2004

[Nonsurgical breast enlargement using a vacuum brassiere for tissue expansion].

We present a method for nonsurgical breast enlargement using a vacuum tissue expander and describe the first so-treated patient in Germany. The patient wore a brassiere-like system that applied a mild (average 20.4 mm Hg) vacuum distraction force to each breast for 10.6 hours/ day over a 10-week period. An increase of 5 cm chest circumference at the nipple level from 85 cm to 90 cm was measured at the end of the therapy. At 3 months follow-up visit, after resorption of the therapy-induced edema, there was still a gain of 4 cm resulting in a 89 cm chest circumference as well as natural attractive breast shape. Side effects included the brief occurrence of irritant contact dermatitis and folliculitis during therapy. The supposed mechanism is analogous to other tissue expansion methods, where tissue growth is a response to continuous controlled mechanical forces. This nonsurgical and non-invasive alternative for breast enlargement appears effective and well-tolerated. Because the only relevant side effects involve the skin, dermatologists are well-suited to perform the treatment.

Adult↗