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At least 325 records · Page 18Linked to original sources
PubMed1993

Cosmetic reconstruction of the mons veneris and lower abdominal wall by skin expansion as the last stage of the surgical treatment of bladder exstrophy: a report of three cases.

The results of the correction of the medial scar depression and diastasis of the pubic hair of the mons veneris in three postpuberal female patients operated on for bladder exstrophy are reported. The reconstructive surgery is carried out using skin expanders. The expanded skin is utilized to create two dermoadipose flaps to fill the medial depression, to outline again the public hair areas, and to allow sutures without tension.

Abdominal Muscles↗
PubMed1993

Fixed membranous bone graft survival after recipient bed alteration.

The effectiveness of membranous bone grafting in craniofacial reconstruction is hindered by resorption. The aim of this study was to determine whether alterations of the recipient bed through tissue expansion affect membranous bone graft survival. Eighteen adult rabbits were divided into three groups. Group I rabbits (control) received fixed autologous membranous bone grafts to their snouts. Group II rabbits had self-inflating tissue expanders inserted over their nasal dorsum, inflation for 3 weeks, and then expander removal and placement of fixed autologous membranous bone grafts to their snouts. Group III rabbits varied from group II by delaying bone grafting until 2 weeks after expander removal. One animal from each group was killed at post-grafting days 15 and 45, the remainder at day 90. Results were assessed by volumetric, nondecalcified histologic, and stereologic analysis. Volumetrically, group I grafts demonstrated 82 percent survival, whereas group II demonstrated 101 percent (p = 0.029) and group III 94.5 percent (p = 0.21). Histologically, group I grafts exhibited greater loss (i.e., porosity and resorption) and less labeling activity. Groups II and III showed extensive evidence of trabecularization and incorporation at the graft-host interface. Stereologic measurements such as osteoid seam width (OSW) confirmed the greater survival and activity of groups II and III bone grafts. Group II OSW measured 12.4 microns, group III 12.0 microns, and group I 9.8 microns (p = 0.04). Stereology also demonstrated that groups II and III's OSW approached that of the recipient bed and contralateral zygoma, whereas group I did not (p = 0.029), suggesting an integration of the graft and host architectures.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Tissue expanders in the lower face and anterior neck in pediatric burn patients: limitations and pitfalls.

Radovan's 1982 landmark work on the clinical use of tissue expanders was felt to be a panacea for multiple reconstructive problems. We have used and probably overused tissue expanders for reconstruction of many complicated pediatric facial burn problems. This has enlightened us to some of the limitations of their use, and we have, therefore, reassessed our indications for their use. From 1984 through 1990, 52 tissue expanders were used in 37 pediatric patients for face and anterior neck burn scar resurfacing. This experience, combined with the unique problems encountered with face and neck tissue expansion, provided the groundwork for operative guidelines. The long-term effects of gravity, growth, and scarring on facial features adjacent to expanded skin led to the following principles. (1) Caution should be used in advancing expanded neck skin beyond the border of the mandible. The risk of scar widening or possible lip or eyelid ectropion needs to be considered when planning these flaps. Extreme overexpansion is necessary to advance unburned neck flaps over the mandibular border to avoid these problems. (2) After advancement or rotational flaps neck flaps to the face, vertically directed suture lines in the neck may need redirection to prevent linear contracture. This correction may be performed during the primary operation or during revisions. (3) Expanded cheek or neck skin should preferably replace burned areas, but at the same time, not violate unburned facial aesthetic units. (4) To counteract the affects of gravity, expanded cheek skin in conjunction with expanded neck skin, if unburned, may be the best choice for face or mandibular border scar replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Simultaneous construction of an internal and external nose in an infant with arhinia.

We report on the simultaneous construction of an internal and external nose in an infant born with arhinia. The indication for this very early reconstruction was due to respiratory distress and the associated feeding problems. It was possible to create two nasal cavities separated by a septum and to form an external nose from pre-expanded skin and a secondary arm flap for the tip supported by a frontal bone flap with intrinsic growth potential and auricular cartilage grafts for the tip. The 4-year-old child has excellent function of the nose with an acceptable appearance. Her psychological development is normal. Respiratory distress and associated feeding problems necessitated the use of oropharyngeal and orogastric tubes in a female infant born without a nose (arhinia). Over a period of many weeks, with attempts to remove the tube resulting in aspiration, we decided to create a functional nasal airway and an external nose simultaneously at this early stage. At the age of 20 weeks, two nasal cavities were created by using a buccal sulcus incision and connected to the existing nasopharynx and partially lined with split skin grafts. An external nose was created using the expanded midfacial skin and supporting it, an osteoperiosteal flap from the frontal bone. Later, a Tagliacozzi flap had to be added for the nasal tip. The newly constructed nose functions well and appears to aid favorably in the normal psychosocial development of the now 4-year-old girl.

Female↗
PubMed1993

Clinical and experimental evaluation of intermittent intraoperative short-term expansion.

To assist in the closure of defects in the region of the head lack and neck, a number of surgeons recommend intermittent intraoperative short-term expansion to exploit the biomechanical properties of the skin. It was the aim of this study to assess quantitatively the amount of intraoperative "tissue gain," to analyze its origin, and to throw light on its underlying biomechanical processes. A total of 285 expansions in 5-minute intervals under a constant tissue pressure of 100 mmHg were performed on 30 patients with severe microtia. The volumes achieved were protocolled, and microcirculation was monitored with the help of a laser-Doppler flowmeter. Expanders exerting a tissue pressure of 100 mmHg for more than 80 cycles lasting 20 minutes also were employed in five dogs. Apart from determining the volumes, changes in distance between the skin tattoos and the diameter of the expander base were recorded. A volume increase of about 10 percent per hour was recorded for the human patients and an increase of about 30 percent per hour for the animals. After reaching a maximal increase in length of 15 to 20 percent, there was no further skin elongation despite increasing volumes. Instead, the expander began to move into the subcutaneous tissue so that its diameter showed a continuous increase. We can conclude on the basis of these results that the increase in volume during intermittent intraoperative short-term expansion is not caused by the proclaimed "creep" behavior of the skin.

Animals↗
PubMed1993

Morphologic analysis of tissue-expander shape using a biomechanical model.

Using a biomechanical model designed to reproduce the forces exerted by the soft tissues of the chest wall, the contours created by several currently available round as well as anatomically shaped tissue expanders were evaluated. Parameters that describe expander shape were defined, the most useful of which proved to be the point of maximal projection and the percentage of upper pole deformity. Direct comparison of seven different expanders with respect to these variables revealed the anatomically shaped expanders to offer improved contours over traditional round designs. Continuing modifications in expander design should focus on lowering the point of maximal projection and minimizing the upper pole deformity.

Biomechanical Phenomena↗
PubMed1993

Comparison of rapid versus slow tissue expansion on skin-flap viability.

The effect of rapid versus slow tissue expansion on random-pattern skin-flap survival lengths was evaluated in two groups of pigs. Each group (group 1--slow; group 2--rapid) was further evaluated for the effect that delay (A), delay plus expansion (B), expansion only (C), and acute flap elevation (D) had on flap length viability. Intergroup and intragroup comparisons were made. In the slowly expanded group, significantly greater flap length viabilities were demonstrated in the slow expansion flaps as compared with the delay plus expander flaps and the delayed flaps, respectively. In the rapidly expanded group, the flap length viabilities of flaps C, B, and A were statistically equal. However, the flap length viability of the rapidly expanded flaps was statistically equal to that of the slowly expanded flaps (C1 = C2). The effect tissue expansion has on improving flap length viability as compared with the delay phenomenon may be related to the combination of a delay effect plus increased nutrient flow density that slow expansion produces. This combined metabolic enhancement is preserved with rapid tissue expansion.

Animals↗
PubMed1994

Sonographic evaluation of dermis and subcutaneous tissue during and after skin expansion.

Soft-tissue thickness modifications were evaluated by high-resolution ultrasound sonography in six patients undergoing skin expansion, with the aim of investigating the possible use of this noninvasive method in the routine monitoring of soft tissues during and after skin expansion. Both during expansion (decrease) and in the postoperative period (increases up to 100 percent or more of the baseline preoperative value), changes in fat thickness occurred faster and were greater in magnitude than those in dermal tissue, overall gradual and limited. In our series, the values of fat thickness ranged between 44 (at full-expansion time) and 140 percent (2 months after expander removal), with a highly significant difference (p = 0.0003), while dermis thickness values ranged between 83 and 114 percent, respectively, showing no significant difference (p = 0.71). Some echo-structural dermal modifications were found by the 20-MHz probe at full skin expansion only. High-resolution ultrasound sonography may be proposed as a noninvasive method in the routine monitoring of soft tissues during and after skin expansion.

Adipose Tissue↗
PubMed1994

Preexpansion galeal scoring.

Preexpansion scoring releases the inflexible galea, permitting more rapid expansion of the scalp. In addition, when comparing this procedure with conventional scalp expansion, patients reported less pain when the galea was incised prior to insertion of the tissue expanders.

Humans↗
PubMed1994

Three-dimensional imaging of Poland's syndrome.

Use of a three-dimensional CT scan as an adjunct for planning chest-wall and breast reconstruction in Poland's syndrome is presented with follow-up MRI with three-dimensional reformation to demonstrate the results of the implant reconstruction. The imaging techniques are capable of accurately portraying the three-dimensional tissue deficit and asymmetry. This imaging may assist in the choice of muscle transposition flaps and reconstructive technique.

Adolescent↗
PubMed1994

Tissue expansion in facial reconstruction.

The tissue expansion technique is advantageous in facial reconstruction because it makes it possible to resurface even wider defects with neighboring skin similar in color and texture and superior to skin obtained elsewhere, thereby surpassing conventional methods. However, there still remain some problems relating to procedural details, such as the selection of tissue expanders and sites of their insertion; the design, elevation, suturing, and fixation of the expanded flap; and the management of free margins such as the lower lip and lower eyelid. In each case, some modification is required with respect to the status of the defect. The experiences encountered in a series of 23 patients are described, with illustration of several representative cases, and advantages and problems are discussed.

Adolescent↗
PubMed1995

Safety of clinical overinflation of tissue expanders.

Despite adherence to a rigorous methodology with precise preexpansion calculations that culminate in the selection of an appropriate implant, the predicted surface area gain after completion of tissue expansion often falls short of the clinical requirements. Rather than then resorting to serial expansions, cutaneous overexpansion usually can be achieved to reach the desired dimensions by overinflation of the implant even well beyond the vendor's stated maximum volume. Over the past decade in a series of 69 patients using 97 tissue expanders, some degree of overexpansion was utilized in 53 implants (54.6 percent). No adverse sequelae due to mechanical failure specifically attributable to this hyperinflation occurred. Complications in the overinflation group (18.9 percent) actually were significantly fewer than those observed in the underexpanded (41.9 percent) (p < 0.03) but were similar in classification. Rather than any inherent superiority in the former group, this observation probably more accurately reflects the fact that overexpansion rarely could be done practically after a significant complication. In any event, the proven safety of limited clinical overexpansion allows a margin of error in the initial choice of implant volume and later permits continued expansion if more tissue than originally anticipated is needed.

Equipment Failure↗
PubMed1995

The application of skin external expander to postburn advanced scar contracture.

In recent years, the universally used internal expansion by implanting a silicone elastomer balloon into the soft tissue under the skin has shown certain disadvantages, i.e., certain complications associated with the operation, high cost, and the fact that the materials cannot be recycled. That the materials are used only once adds to the operating cost. In view of these disadvantages, we have designed and developed a kind of mechanical external skin expander, which is composed of (1) an adjustable tractor, (2) preserving splints, and (3) a traction frame. The tractor is used to grip the contracted skin in order to make the soft tissue of the skin expand with the lapse of time and increase in traction weight. The external skin expansion has the following advantages compared with internal expansion: avoiding the complications caused by implanting the soft-tissue expander beneath the skin; simplicity and efficiency of operation; and the fact that the equipment can be reused, reducing the operating which is suitable for these basic units. The data of the expanded skin area can be calculated through the computer. Since June of 1993, a satisfactory curative effect has been obtained in 44 patients suffering from advanced postburn scars. Thirty-two patients among them were treated for more than half a year, with the scar becoming normal in both appearance and function. External skin expansion provides a new method for expansion of skin soft tissue. It has a bright future in its clinical application.

Adolescent↗