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At least 271 records · Page 15Linked to original sources
PubMed1994

Smooth versus textured expander implants: a double-blind study of capsule quality and discomfort in simultaneous bilateral breast reconstruction patients.

Textured silicone expanders are alleged to be less painful in the filling process, to have less capsular contracture, and to stay in position better than smooth silicone expanders. To test these three hypotheses, 6 patients undergoing bilateral simultaneous expander implant placement for breast reconstruction after mastectomy were studied. In a double-blind fashion, after smooth and textured implant placement (one in each side) and initial wound healing, each patient was sequentially expanded with equal volumes of saline. In each patient, at each expansion, pressure data, discomfort scores, and implant placement measurements were made. At implant removal, smooth and textured capsule tissues were studied for collagen type content and ability to contract the patient's own fibroblast-populated collagen lattice. In 4 of 6 patients the smooth expander was associated with lower injection pressures and less discomfort. In all patients the expanders maintained their position, except in 1 patient whose smooth implant shifted laterally. The capsular collagen typing and fibroblast-populated collagen lattice studies demonstrated no difference between smooth and textured capsules. In this double-blind clinical study in simultaneous bilateral breast reconstruction patients we could not confirm the suggestion that textured silicone expanders produce less capsular contracture and cause less pain with injection.

Adult↗
PubMed1994

Diffusion of antibiotics across tissue expanders: an in vitro study.

Local infection remains a significant complication of tissue expansion. Subclinical infection of pockets with permanent prosthesis used in breast reconstruction has also been associated with capsular contracture around the implant. In an in vitro model, we used four groups of eighteen 50-ml tissue expanders, each containing Bactrim, Ancef, Nafcil, or saline only, in beakers containing fresh frozen plasma, placed in a rotary shaker for 48 hours. Inoculums of Staphylococcus aureus and Staphylococcus epidermidis were then selectively added to the medium external to the expanders in each group. The growth of such strains was found to be variably inhibited. We thus determined that antibiotics can diffuse through a tissue expander's Silastic membrane and establish an efficient bacteriostatic level in the surrounding fluid. This information could have potential clinical application in reducing infections associated with the use of expanders.

Anti-Bacterial Agents↗
PubMed1994

Scar-length reduction by ring-shaped expansion.

Conventional tissue expansion with rectangular or round expanders often results in considerable dog-ear formation and, after resection, in lengthening of the final scar. The resulting scar is, always much longer than the maximal diameter of the skin lesion. These disadvantages are partially avoided by the use of croissant-shaped expanders. Taking the idea of the croissant-shaped expander and thinking further in terms of differential expansion, a new expander has been designed. It consists of a ring-shaped expander that is placed under the normal skin around the lesion. When the appropriate expansion is reached, the skin lesion is excised and the defect is closed with a running subcuticular suture, pulling as much skin as possible centripetally. The resulting scar is shorter than the maximal diameter of the skin lesion. The new expander has been tested in two patients in regions that are reputed for poor scar quality (the back and the upper arm). The results are encouraging.

Adult↗
PubMed1995

Tissue expansion-assisted prefabrication of the forehead flap for nasal reconstruction.

A new technique for nasal reconstruction is described. This method--expansion-assisted flap prefabrication--is essentially a simultaneous application of pretransfer grafting and tissue-expansion procedures for creating custom-made forehead flaps to meet varying requirements of nasal reconstruction. We have applied this new technique on seven patients, with full-thickness nasal defects during a 3-year period. Results from these patients are presented with a review of different use of flap prefabrication principles in nasal reconstruction.

Adolescent↗
PubMed1995

Facial plaque-type blue nevus and its reconstruction.

Blue nevi rarely appear in a plaque form. Because of their rarity and unusual clinical appearance, these nevi may present a diagnostic problem. We described a large plaque-type blue nevus measuring about 9 x 6 cm on the right cheek of a 22-year-old man. It was characterized by several dark-blue macules and papules with intervening areas of faint blue discoloration. Excision of this unusual plaque-type blue nevus with reconstruction using tissue expander was performed successfully. A 6-year postoperative follow-up revealed satisfactory results.

Adult↗
PubMed1995

Tissue expanders and magnetic resonance imaging: the "hot" breast implant.

Magnetic resonance imaging (MRI) utilizes three electromagnetic fields to create images. Despite these electromagnetic fields and concern for patients with metallic implants, studies and clinical experience have demonstrated the safety of this modality in the presence of nonferromagnetic implants. However, little has been written about the use of MRI scans in patients with tissue expanders. We present a case of a woman who developed a burning sensation at the site of her tissue expander during an MRI scan. The sensation resolved rapidly once the scan was discontinued. The potential for metallic heating or motion within the electromagnetic field is discussed. Patients with tissue expanders who require MRI scans should be carefully questioned about localized symptoms in the region of their expander during the scan. However, the actual implications of the symptoms for this group of patients are unclear.

Breast Implants↗
PubMed1996

Chest wall deformity following maximal tissue expansion for breast reconstruction.

Forty-three women, in a series of 150, participated in a prospective study that examined their chest walls for deformities 3 months after maximal tissue expansion for single-breast reconstruction. Computed tomography imaging was used for this purpose. Twenty-one patients underwent immediate breast reconstruction and the other 22 patients underwent delayed reconstruction. Fifty-three percent had some chest wall abnormality. In the delayed group, chest wall deformities were more statistically significant (p < 0.001). Our findings suggest that chest wall deformity is a common occurrence after maximal tissue expansion for breast reconstruction.

Adult↗
PubMed1996

The surgical management of cranio-orbital neurofibromatosis.

Experience with the surgical management of cranio-orbital neurofibromatosis in 14 patients is reported (age range, 6-40 years). The skeletal abnormality of the orbit that occurs in a small proportion (less than 1%) of patients with neurofibromatosis is, in essence, the absence of the membranous portions of the sphenoid and the adjacent bone forming the boundaries between the cranium and the orbit. The goal of surgery is tumor resection and reconstruction of the posterior bony defect by bone graft. Two additional procedures are also described that better enhance aesthetically-the mask lift and facial tissue expansion.

Adolescent↗
PubMed1996

Staged reconstruction of abdominal wall defects after intra-abdominal catastrophes.

Advances in surgical intensive care have improved survival in patients with major traumatic or infectious intra-abdominal insults. Patients who recover are often left with massive abdominal wall defects. Sufficient autogenous tissue may not be available for reconstruction and synthetic mesh followed by skin grafting can lead to unaesthetic results or complications. We report on four patients with abdominal wall defects and their reconstruction after intra-abdominal injury. Treatment involved local wound care to stimulate granulation tissue, which is eventually skin grafted to close the wound. Patients are then allowed to make a full recovery. Soft-tissue expanding prostheses are placed during a second operation and inflated over subsequent weeks. Finally, the skin graft is excised, a polytetrafluoroethylene patch is placed into the fascial defect, and the expanded skin is used to achieve wound closure.

Abdominal Muscles↗
PubMed1997

Endoscopic pediatric plastic surgery.

Although the advent of endoscopic technology is expanding the fields of reconstructive and aesthetic surgery in adults, there have been to date no reports of its use in the pediatric population. Because of its minimally invasive nature, yet wide range of exposure, endoscopic techniques have much appeal in this age group. Herein we present our initial experience with endoscopic pediatric plastic surgery. From February 1995 to December 1995, 41 patients were treated utilizing 5-mm and 10-mm endoscopes at Scottish Rite Children's Medical Center, Atlanta, GA. There were 19 males and 22 females. The mean age at surgery was 5.6 years (range, 7 months-15 years). The most common types of procedures performed were insertion of tissue expanders (N = 19), excision of facial dermoids (N = 7), torticollis release (N = 5), and excision of vascular lesions (N = 4). The remaining 6 patients underwent a variety of reconstructive procedures. The complication rate in the tissue expander group was 3 out of 39 expanders inserted (9.5%), and consisted of infection (N = 2) and rupture (N = 1). In the dermoid group, complications consisted of wound infection requiring reoperation (N = 1), and transient frontal paresis (N = 1). One patient in the hemangioma group had an incomplete resection necessitating open excision. The remaining patients all had satisfactory outcomes with no complications. The majority of the procedures were done on an outpatient basis. These results suggest that endoscopic techniques are eminently applicable in the pediatric population, providing the benefits of small and remote incisional wounds with complication rates that are comparable to those of conventional surgical treatment.

Adolescent↗
PubMed1997

Immediate breast reconstruction in the high-risk adjuvant setting.

High-dose chemotherapy with autologous stem cell support (or bone marrow transplantation) in the treatment of primary breast cancer has been developed in the hopes of increasing survival among patients traditionally regarded as "high risk". These patients have locally advanced disease (stage IIB or higher) and have a greater than 50% risk of developing systemic illness. This report addresses the issue of whether reconstructive breast surgery can be offered to high-risk patients. It is hoped that as survival among women with advanced or high-stage primary breast cancer increases, options for immediate breast reconstruction can be routinely offered.

Bone Marrow Transplantation↗
PubMed1997

Immediate breast reconstruction in patients with locally advanced disease.

Immediate breast reconstruction for patients with early-stage disease is well established. This study evaluates a consecutive series of 22 patients with locally advanced disease (stage IIB or III) who underwent mastectomy and immediate breast reconstruction. All patients received several cycles of neoadjuvant chemotherapy (average, 3.5 cycles) followed by completion of chemotherapy beginning approximately 3 weeks following surgery. The perioperative morbidity was 14% and no patient suffered a delay in the resumption of chemotherapy. Patients have been particularly grateful about being offered reconstruction in this setting. Our preliminary results with this technique have been encouraging and further study is warranted.

Adult↗
PubMed1997

Tissue expansion in children: a retrospective study of complications.

We retrospectively reviewed 105 consecutive children in whom 191 tissue expanders were placed by the Plastic Surgical Service at The Children's Hospital from 1987 to 1995. The age range was 1 month to 28 years. The series included 68 females and 37 males. The indications for tissue expansion were congenital pigmented nevus (N = 55), craniofacial anomaly (N = 13), aplasia cutis congenita (N = 7), meningomyelocele (N = 7), posttumor resection (N = 5), unstable scar (N = 4), burn scar (N = 3), and miscellaneous disorders. The expanders were located in the scalp (N = 59), cervicofacial area (N = 23), back (N = 18), chest (N = 6), and extremities (N = 6). A single expander was used in 47 patients and the mean number of expanders per patient was 1.8. All patients were given preoperative intravenous antibiotics. There were 25 complications in 20 patients (19%), which comprised 13% of all expanders. The most common complications were infection (6%, N = 11), deflation (3%, N = 6), and exposure (2%, N = 5). These complication rates were not related to either the gender, site of implantation, number of expanders, use of closed suction drains, or the indication for expansion. The complications were related to age, being higher in children (age 1-12 years) compared with infants and adolescents. Tissue expanders can be successfully used in children to construct and reconstruct a variety of cutaneous defects, but there is an irreducible minimum for the three major complications.

Adolescent↗
PubMed1997

Calvarial deformity and remodeling following prolonged scalp expansion in a child.

A main concern in the use of scalp tissue expansion in the pediatric population has been the risk of skull deformation. Little is known about the long-term effects of tissue expansion on the skull and the ability of the skull to remodel following removal of the tissue expander. We report a recent case in which a 5-year-old boy had a fully inflated tissue expander retained under the scalp for a 15-month period. At surgery for removal of the implant the patient was noted to have a profound skull deformity characterized by severe calvarial depression and ridging. The patient underwent scalp reconstruction. Follow-up at 6 months revealed nearly complete remodeling of the skull with minimal visual deformity. This case demonstrates not only the profound bony deformity that can result from tissue expansion, but also the striking ability of the pediatric skull to remodel.

Bone Remodeling↗
PubMed1998

Use of pedicled flaps and tissue expanders to reconstruct burn scars of the skin of the anterior abdomen and chest.

Extensive scarring of the skin of the abdomen and chest is sometimes encountered postburn. It is possible to excise the burn scar serially and replace it with unburned skin from areas such as the lower abdomen by means of various advancement flaps. Expanders may be inserted to facilitate coverage as indicated. We report 9 patients (3 males and 6 females) in whom such staged procedures were carried out. Original burn size ranged from 4% to 52%, with a mean total body surface area of 23.8%. No major complications or blood loss requiring transfusion were encountered.

Burns↗