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At least 253 records · Page 14Linked to original sources
PubMed1991

Breast reconstruction: systemic factors influencing local complications.

One hundred seven consecutive breast reconstructions in 83 women were retrospectively reviewed. The reconstructions were with subpectoral prostheses, 54 with permanent tissue expanders, 14 with temporary tissue expanders, and 39 with permanent implants. Immediate breast reconstruction was performed in 69 (64%) breasts and delayed breast reconstruction in 38 (36%) breasts. Risk factors for local complication were diabetes, smoking, age older than 60 years, obesity, and hypertension. Technical factors reviewed included timing of reconstruction, type of prosthesis used, and the presence or absence of drains. Women with immediate breast reconstruction sustained a significantly higher complication rate than women with delayed breast reconstruction; however, the majority of these were due to the antecedent mastectomy. Complications due to the reconstruction were not significantly different for women with immediate versus delayed breast reconstruction. Implant loss occurred in 5 women, 4 with immediate and 1 with delayed breast reconstruction (5.8% vs. 2.6%, p approximately 0.47). Diabetes was significant, and smoking and age greater than 60 years approached significance as risk factors for implant loss in women with immediate breast reconstruction (p approximately 0.01, 0.05, and 0.08, respectively). These risk factors also correlated directly with an increasing severity of complication in women with immediate breast reconstruction (r = 0.414, p = 0.06). Technical factors showed no significant effect on implant loss in women with immediate breast reconstruction.

Adult↗
PubMed1991

Lidocaine diffusion in five tissue expanders: an in vitro and in vivo study.

Previous work in our laboratory has demonstrated that tissue expanders are permeable to lidocaine. In this two-part study, we assessed the in vitro lidocaine diffusion in the following five common tissue expanders: Dow Corning, McGhan, Cox-Uphoff, Hyer-Schulte (Mentor), and Surgitek. In part 1, we demonstrated that wall thickness appeared to be the major determinant for diffusion. Part 2 reports an in vivo study of lidocaine diffusion from tissue expanders used for breast reconstruction. We initially determined that there is incomplete mixing between the valve and connecting tubing and the contents of the expanders, over the period of 1 week. We subsequently examined the lidocaine diffusion from seven tissue expanders placed in a submuscular position for breast reconstruction. The rate of lidocaine diffusion was highly variable, but on average was about 3% per day.

Diffusion↗
PubMed1991

Steroid and benzyl alcohol diffusion through tissue expanders and double lumen breast implants.

The rate of diffusion of benzyl alcohol (the bacteriostatic agent in the provided diluent) and methylprednisolone 21-hemisuccinate and related rearrangement and hydrolysis products ("steroid") through tissue expanders was examined. The rate of diffusion of steroid through double lumen breast implants was also studied. It was found that benzyl alcohol rapidly diffused through tissue expanders into a saline bath. By 24 hours, one-half of the benzyl alcohol had diffused through the expander. The steroid was much slower to diffuse out of the expander. By 141 days, only 2% of the steroid was found in the bath. This rate was comparable for both the tissue expander and double lumen implants. In addition, a significant amount of the steroid is located in the expander wall, associated with the surface of the expander or precipitated out of solution or both. The clinical significance of these findings is discussed.

Benzyl Alcohol↗
PubMed1992

Surface area and tissue volume increases with differential expansion.

Increasing sophistication in generating soft tissue by tissue expansion has resulted in the evolution of differential expanders. These prostheses attempt to asymmetrically generate tissue for specific reconstruction, most commonly the breast. Using the pig model, differential expanders were placed in the rib area. A square grid was marked over the area, and the expander inflated. For each grid subunit, the surface area was calculated, the thickness measured, and the volume calculated. Subunits in the area of preferential expansion exhibited the greatest increase in surface area, however, these same subunits exhibited pronounced thinning of the tissue. The corresponding volume of these subunits was greater than that of nonexpanded subunits, but the increase was less than when comparing subunit surface area. All expanders were displaced superiorly during the course of inflation. These findings are of clinical significance in that the mastectomy scar and nipple reconstruction both are situated in the area of minimal thickness. Displacement of differential expanders must be anticipated so that the resultant inframammary fold will ultimately be symmetrical with the opposite side.

Animals↗
PubMed1992

Intraluminal lidocaine for analgesia after tissue expansion: a double-blind prospective trial in breast reconstruction.

A double-blind prospective placebo controlled trial of intraluminal lidocaine for pain relief after tissue expansion was performed in 18 women undergoing breast reconstruction. In contrast to others' claims of effective analgesia, no difference in the incidence of immediate or late pain after expansion could be demonstrated between 100 mg of lidocaine and placebo. The overall incidence of early pain was 8%. This was significantly less frequent than late pain, which occurred after 36% of all expansions. Postexpansion pain (early or late) was reported after nearly one-half of all expansions, most of which was ascribed to late pain. The incidence of pain did not significantly depend on the temporal progression of breast expansion, nor was there a difference in the incidence and prevalence of pain for patients undergoing unilateral versus simultaneous bilateral expansion.

Analgesia↗
PubMed1992

Breast reconstruction with tissue expanders: obtaining an optimal result.

A large personal experience with breast reconstruction using tissue expanders (149 patients with Radovans, and more than 150 patients with Beckers), with many suboptimal results especially in the early learning stages, has brought about changes in approach offering a much higher probability of acceptable breasts. This report attempts to combine multiple factors useful in yielding such results. Areas addressed include immediate versus delayed reconstruction, selection of candidates, selection of expander type, appropriate placement of expander at a site minimizing the requirement for pocket modification, choosing the optimal size expander, importance of maximal overexpansion to yield a good submammary fold, and means of determining adequate overexpansion to match an unmodified contralateral breast and the risks inherent in overexpansion. Timing, interval, and length of maintenance of hyperexpansion are described along with deflation and timing of port removal. Both the skate and star techniques of nipple and areolar reconstruction in the hyperexpanded patient yield very acceptable results despite thinned skin and minimal subcutaneous tissue. Good, satisfactory, and suboptimal clinical results will be presented. In our experience, tissue expansion reconstruction offers distinct advantages in a large majority of patients with the proviso that patients are willing to accept the time required for hyperexpansion and the waiting period for deflation.

Female↗
PubMed1992

Tissue expansion in the extremities using external reservoirs.

Over a 24-month period, 18 patients had 33 expanders placed in the extremities. Twelve expansions were performed in the upper extremity, and 21 in the lower extremity. Indications for expansion include scarring, excision of skin grafts, tumor excision, burn scars, tattoos, or unacceptable incisional scars for revision. Of the 12 expansions performed in the upper extremity in seven patients, nine were successful. Nine expansions in the thigh and two expansions in the region of the knee were completed without complication. Three expansions were performed in the distal lower extremity following crush injury to remove scarring, and all three failed. Seven expansions were performed in the foot for removal of scarred tissue. There was one infection, two skin necroses on the dorsum of the foot, and one implant exposure. Seven complications in the lower extremity occurred in these areas with an infection rate of 20%. The remaining 23 expansions were performed for soft tissue defects in the upper extremity or in the lower extremity above the level of the mid-calf, with only two complications of implant exposure or infection. Therefore, the infection rate and complication rate in the upper extremity and above the knee was only 6%. Overall, 23 of the 33 expansions, or 70%, were taken to completion with a successful advancement of expanded flaps. Overall, complications occurred in 30% of patients, all eventually requiring removal of the expander.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Cleft lip repair by soft-tissue expansion.

I report herein a newly devised method of cleft lip repair that involves the expansion of cheek skin by tissue expander and transferring the scar from the philtrum to the nasolabial fold, or reducing a broad scar to a finer and less conspicuous one without leaving tension. The method, having been applied in three patients with good results, is thereby recommended for patients with severe cleft lip deformity wherein a tight lip is present.

Adolescent↗
PubMed1992

Tissue expansion in a patient with extensive nevus comedonicus.

Nevus comedonicus is a rare developmental abnormality of the pilosebaceous apparatus that presents as an aggregation of dilated follicular orifices filled with pigmented keratinous material. Occurrence of extensive or giant lesions is even more rare. Indications for treatment include recurrent infections and cosmetic reasons. Therapeutic approaches include topical keratolytic agents, manual extraction of comedones, dermabrasion, and excision of smaller lesions. Increasing clinical experience with tissue expansion has suggested that it might be used effectively in the definitive treatment of an extensive nevus comedonicus previously considered too large to excise without the use of a skin graft, despite the potential risk of infection within the lesion during the course of expansion. We report the first patient with giant nevus comedonicus to be treated using tissue expansion. This patient demonstrates that prompt treatment of cellulitis and abscesses within the lesion will keep this process isolated from the adjacent expanders and will not compromise a planned excision and reconstruction.

Buttocks↗
PubMed1992

Tissue expansion of sensate skin for pressure sores.

The surgical treatment of pressure sores has improved with the development of many techniques to provide coverage of these defects. Few deliver sensate coverage. This report describes tissue expansion of back skin to provide definitive sensate coverage of a pressure sore, thereby preventing its recurrence. Follow-up of 5.5 years is presented with a review of the literature.

Adult↗
PubMed1993

Tissue engineering of biomaterials for composite reconstruction: an experimental model.

The fibrovascular integration of a biomaterial scaffold was examined in a rabbit model. Eight disks of expanded polytetrafluoroethylene measuring 2 x 2 x 0.2 cm were placed adjacent to dissected vascular pedicles in the ears of four rabbits and sealed between leaves of silicone sheeting. Fibrovascular outgrowth from the vascular pedicles completely integrated the biomaterial scaffolds by 6 weeks and was sufficient to sustain split-thickness skin grafts. Division of the distal vascular pedicle allowed isolation of the blood flow circuit to the construct. Successful microsurgical transfer was achieved in one construct. This model has proved useful in the study of tissue engineering of biomaterials for reconstruction and may well have use in the study of neovascularization as an isolated event.

Animals↗
PubMed1993

Superiority of the fasciocutaneous flap in reconstruction of sacral pressure sores.

The gluteal maximus muscle has been used in the treatment of sacral pressure sores since the 1970s. However, it is noted that the muscle portion of the transferred flap shows highly atrophic degeneration and the muscle itself is not suitable tissue for covering the pressure-bearing area. We have managed various fasciocutaneous flaps as the first choice for reconstruction of sacral pressure sores and obtained good results. The fasciocutaneous flap has an anatomical structure that resists physical stimulation or external pressure and an abundant blood supply via its fascial plexus. In addition, if we use a gluteal maximus myocutaneous flap at first, some fasciocutaneous flaps are compromised because of the design and blood supply. We suggest that the fasciocutaneous flap has the first priority and is superior to the gluteal maximus myocutaneous and muscle flaps in reconstruction of sacral pressure sores.

Adult↗
PubMed1993

The expanded forehead flap for nasal reconstruction.

A 3-year experience using forehead tissue expansion for nasal reconstruction is presented. The series includes 7 expansions in 6 patients with different degrees of nasal loss due to either cancer, trauma, or avascular necrosis. Balloon tissue expansion minimizes the well-known limitations and drawbacks found in using forehead flaps for nasal reconstruction. Technique, timing, and sequencing of procedures are discussed and compared with those of other authors. The complications of tissue expansion are few, but obtaining a satisfactory nasal reconstruction requires multiple operations over a period of time. A learning curve is necessary due to inadequate previous experience and new developments in tissue expanders. The results obtained were possible due to the excellent tissue provided by forehead expansion.

Adult↗
PubMed1993

"Off-the-shelf" techniques for continuous tissue expansion.

Since modern tissue expansion was introduced in 1976, it has proved to be a safe and effective technique for obtaining extra tissue where traditionally distant flaps and grafts had been used. However, the lengthy expansion times and prolonged gross deformity of conventional expansion protocols have often deterred both physician and patient from choosing this reconstructive option. Over the past decade, attempts to shorten the total expansion time have centered around decreasing the time intervals between injections. Recently, researchers at Washington University have developed the technique of continuous tissue expansion (CTE), using a custom-designed, computerized pump. With CTE, expansion times have been shortened from 2 weeks to 3 days. At our institution, we have demonstrated that CTE can be safely and economically performed with the use of equipment already existent in most medical centers. We describe the equipment and technique and present two cases of successful clinical application of CTE.

Adult↗
PubMed1993

Scrotal construction by expansion of labia majora in biological female transsexuals.

Construction of male genitalia in biological female transsexual patients is problematic. We report 3 transsexuals with scrotal construction by tissue expansion of the labia majora. In each patient, tissue expanders were inserted into the labia majora several months before free flap phalloplasty. In 2 patients, the tissue expanders were removed, and testicular implants were placed into the labial pockets. In the other patient, the tissue expanders were left in place. Because of the close embryological relationship between the labia majora and the scrotum, the neoscrotum appears natural in color match, hair pattern, and skin texture. The anatomical position of the labia majora produces a scrotum properly located in relation to surrounding anatomical structures. Excellent aesthetic results can be achieved with this procedure. Based on our experience, we advocate this procedure for scrotal construction in biological female transsexual patients.

Adult↗