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At least 19 recordsLinked to original sources
PubMed1989

Capsular contracture after breast reconstruction with tissue expansion.

Tissue expansion before placement of an implant for breast reconstruction is said to lessen the chance of capsular contracture. Forty-nine patients who had undergone post-mastectomy breast reconstruction using tissue expansion were reviewed. Capsular contracture was assessed using the Baker scale and compared with the speed of expansion, the degree of over-expansion and the interval between full expansion and placement of the definitive prosthesis. The overall incidence of capsular contracture (Baker III or worse) was 29%. Only one patient, however, has required capsulotomy for capsular contracture alone. Neither the speed of expansion nor the degree of over-expansion influenced the onset of contracture. Those patients with breasts assessed in Baker group I had a significantly longer interval between full expansion and reconstruction than those in Baker group III (p = 0.05). A modification of Baker's scale is suggested for the assessment of reconstructed breasts. Prospective studies are required to define the optimum timing for tissue expansion procedures.

Adult↗
PubMedDate not supplied

Tissue expansion.

Tissue expansion has become a popular method of reconstructive surgery over the last few years and is used to reconstruct a wide range of defects. This article aims to outline the technique and results of tissue expansion on the plastic surgery unit in Bradford.

Humans↗
PubMed1992

[Tissue expansion].

Tissue expansion has now achieved an important place in reconstructive surgery, since the first experiments about 10-15 years ago. Expanded tissue used in reconstruction is usually excellently matched for colour, thickness, elasticity and other physical properties. This is particularly important in reconstructions in the head and neck region. Tissue expansion is also used increasingly for breast reconstruction all over the world. It is now the most common procedure for breast reconstruction in USA. Various options using either a temporary or a permanent expander are discussed.

Breast Neoplasms↗
PubMed1990

Basal cell carcinoma: excision with immediate intraoperative tissue expansion.

Tissue expansion in dermatologic surgery has gained wide acceptance. We report the case of a patient with basal cell carcinoma in whom a Foley catheter was used for immediate intraoperative tissue expansion. Wound tension was decreased significantly and primary closure obtained. This technique is appropriate for office surgical procedures and provides an alternative approach to wound closure with flaps and grafts. The Foley catheter is an inexpensive and disposable tissue expander.

Adult↗
PubMed1988

Tissue expansion.

Controlled tissue expansion began as a concept based on primitive ideas and observations. Its application to breast reconstruction has played a major role in the tissue and psychologic rejuvenation following surgery for breast carcinoma. During the last several years, controlled expansion of tissue has been applied to many other anatomic sites treating many difficult reconstructive and excisional surgeries which heretofore were either impossible or required several stages to accomplish. As experience has grown, the use of tissue expansion has become safer and has been applied to many excisional and reconstructive efforts. The future use of tissue expansion is extremely bright and limited only by the creativity of the surgeon familiar with the technique. In the future, under study is controlled expansion of bone, of nerves, and of other body parts that may prove to be valuable in the surgeon's armamentarium. The dermatologic surgeon should become familiar with the concept and practice of tissue expansion, whether or not it is used in his or her practice. By being familiar with what the reconstructive surgeon can do with tissue expansion, the dermatologist can treat entities perhaps not otherwise treated in the past. For the dermatologist experienced in cutaneous surgery, tissue expansion can be added to his armamentarium in the treatment of male pattern baldness, some local flaps, congenital nevi and larger excisions requiring serial excision in the past as well as tattoos.

Humans↗
PubMed1989

Physical, biomechanical, histologic, and biochemical effects of rapid versus conventional tissue expansion.

Clinical tissue expansion has been quite successful but takes 2 to 3 months. This study compares the effects of a conventional tissue expansion regimen of 6 weeks with an accelerated regimen of 2 weeks in the dog model, which is biomechanically similar to the human. In 22 dogs, the skin expanded 34.4 percent in the 2-week and 35.8 percent in the 6-week protocol, excluding stretch and recruitment. There was thinning of the panniculus carnosus in the 6-week group and otherwise no significant decrease in dermal thickness in either group. The biomechanical properties of elasticity and creep did not differ in expanded skin from both groups, while stress/relaxation mildly decreased from a control value of 53.5 percent to 48.8 percent in the 6-week group (p less than 0.05). Collagen activity was increased in both the 6-week and the 2-week groups (p less than 0.001) over nonexpanded skin, and immunohistochemical staining with a monoclonal procollagen antibody demonstrated collagen synthesis by dermal fibroblasts in both groups. We conclude that rapid tissue expansion did not demonstrate any deleterious effects when compared with a conventional regimen.

Animals↗
PubMed1989

Tissue expansion.

Although tissue expansion is unlikely to replace skin grafting and other basic reconstructive procedures in the horse, its continued success in humans will undoubtedly stimulate client interest in its use. Its biggest advantage is the advancement of full-thickness skin over large defects where grafting techniques would not provide the same degree of protection. The resulting cosmetic appearance of the wound is also better.

Animals↗
PubMed1989

Animal models of human tissue expansion.

Although tissue expansion is being used extensively in humans, many fundamental scientific questions remain to be addressed which can best be answered using an animal model. Presently, no single animal has been identified for research of this kind which is comparable both subjectively and objectively to humans. This study evaluates the skin of the rat, guinea pig, pig, and dog and identifies the dog as the best model based on biomechanical and practical considerations.

Animals↗
PubMed1992

Intraoperative tissue expansion: a review.

Tissue expansion is used to facilitate reconstruction procedures following trauma and cosmetic breast augmentation. This article describes tissue expansion, reviews intraoperative expansion techniques, and discusses the nurse's role in the procedure.

Humans↗
PubMed1987

Tissue expansion in reconstruction.

Tissue expansion offers a new alternative in plastic surgery. Its applications are numerous for reconstruction of the scalp, head and neck, trunk, breast, and extremity. Over the past year I have used tissue expansion for reconstruction in 13 patients, with multiple expanders in six patients. Complications included two exposed expanders requiring early removal, and two mechanical malfunctions requiring replacement. Expansion of previously irradiated tissue has been unsatisfactory.

Abdominal Muscles↗
PubMed1989

Tissue expansion in perspective.

Tissue expansion is a recent advance in skin cover technique. Its empirical use has enabled many previously difficult reconstructions to be completed without recourse to distant flaps. Its high complication rate and lack of basic scientific understanding at present restrict its use to selected cases, but the quality of repairs possible by this method encourage further serious scientific study.

Breast↗
PubMed1990

[Treatment of cicatricial alopecia by the method of tissue expansion].

The tissue extension method was applied in 13 patients with cicatricial alopecia of the scalp. Eighteen Soviet-made tissue expanders were used. Clinical experience showed that the sequelae of burns of the scalp attended by alopecia should be treated by tissue extension. The growth of hair can be restored on up to half of the scalp surface by expansion of the local tissues by their direct transfer and by additional formation of grafts for contour plastics. Plastics by expanded tissues is indicated for closure of naked bones of the vault of the skull.

Alopecia↗
PubMed1989

A control unit for maximal-rate continuous tissue expansion (CTE).

Subcutaneous or submuscular tissue expansion has become a major tool for the reconstructive plastic surgeon in the repair of difficult wounds and in breast reconstruction. This technique can provide additional or replacement tissue with good match in color, sensation, texture and adnexal characteristics. A major limitation of the technique is the time required for periodic tissue expansion to the required volume in the clinical setting, typically taking from a few weeks to several months. Conceptually, the maximum rate possible for safe clinical tissue expansion would result from continuous maintenance of tissue expander pressure just below capillary filling pressure (continuous tissue expansion, CTE). A control device with this capability would have important clinical and research applications. A self-contained portable control unit (patent pending) for CTE has been designed, fabricated, and testing initiated in a dog model. The 4-lb unit includes a 250-cc fluid reservoir, power pack, pressure transducer (Microswitch 160 PC), pump (Spalding 701A), feedback circuits and memory (2-lb power pack, 2-lb controller and reservoir). Preselected constant pressure (15-50 mmHg +/- 0.1 mmHg) can be maintained in a tissue expander with a maximal flow rate of 16 cc/hr for approximately 18 hours before change of the NiCad battery pack. A digital memory records pressure and volume infused and transfers this data to a Macintosh computer after completion of expansion. Verification of this prototype control unit is presently underway. Initial data suggests that the time required for complete filling of a subcutaneous tissue expander in a dog model can be reduced to approximately 72 hours. Several potential clinical applications and variations of this device are discussed.

Animals↗
PubMed1991

Soft-tissue expansion in lower extremity reconstruction.

Soft-tissue expansion in the lower extremities is typically well tolerated. The more proximal one is--that is, the closer to the thigh and buttocks--the easier and less complication prone the expansion will be. It is another valuable technique for resurfacing the lower extremity and for reconstructing defects in contour and in skin character. There are limitations to this technique, which generally is most useful in late reconstructions. Intraoperative expansion has no place in lower extremity reconstruction. Soft-tissue expansion may be limited by an unsuitable geometry or the sheer size of defects. It should not be used next to open wounds. Soft-tissue expansion offers significant advantage in that the coverage of a defect will be replaced with tissue like that lost. Seldom does one see necrosis of advanced flaps, so that there is little risk of tissue loss in using this modality. There is an excellent vascularity to the flaps and an excellent character to the skin. In addition, in this cost-conscious era, soft-tissue expansion is quite cost effective, and in many cases the procedures can be conducted on an outpatient basis with a minimum of hospitalization, if any. With care to select patients properly, design carefully, and conduct expansion in a leisurely fashion, soft-tissue expansion offers a valuable means of reconstructing both large and small lower extremity defects.

Adult↗
PubMed1988

Soft-tissue expansion in the lower extremities.

Soft-tissue expansion enjoys ever-wider use, but to date an experience using this technique in the lower extremity has never been presented. We reviewed our first 16 patients to describe the indications and contraindications for the use of tissue expansion in the lower extremity. Guidelines evolved from study of the data. Soft-tissue expansion merits consideration for coverage of problem wounds, in preparation for removal of large benign lesions, and for the repair of contour defects. The operator should know that an open wound below the knee predicts a complication if soft-tissue expansion is attempted in that location. In the thigh, incisions can be confidently placed at the edge of the defect. In every location, large expanders should be chosen so that they are as long as or longer than the adjacent defect. The increase in circumference of the limb should be followed. Simple designs for advancement flaps usually work well. As our experience has grown, reconstruction using soft-tissue expansion in the lower extremity has become safer and the results more predictable through better patient selection and diligent monitoring of intraluminal pressures, even if only by ensuring that the patient is always comfortable. Soft-tissue expansion has a role in reconstruction of the lower extremity.

Adolescent↗
PubMed1990

Clinical applications of tissue expansion in head and neck surgery.

Tissue expansion offers a new frontier in head and neck reconstruction in that it provides the capability of creating additional new skin for restoration of defects with skin of identical color, thickness, and appendages. The applicability of tissue expansion is only beginning to be appreciated as it is used in various aspects of head and neck surgery. Currently, the technique is most frequently used in scalp surgery for correction of male pattern baldness. Other uses of tissue expansion are in cranial facial surgery and expansion of distant, regional, or microsurgical flaps. Perhaps its greatest value from a reconstructive perspective, however, is in providing new skin for reconstruction of various facial defects through the use of primary wound closure or a multitude of local flaps.

Cheek↗
PubMed1989

[Technic of tissue expansion].

The technique of tissue expansion is rapidly developing. It resolves certain problems encountered in plastic and reconstructive surgery, in the scalp, for example, which constitutes an ideal indication. A correct strategy and technique, together with well defined indications allows a very significant reduction in the complication rate. The choice of prosthesis and its location also play an important role. There are many indications in the scalp, but tissue expansion may also be useful in Poland's syndrome, in giant naevi in children and for expansion of certain flaps. Rapid intra-operative expansion also appears to be a promising technique.

Cicatrix↗