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At least 343 records · Page 19Linked to original sources
PubMed1997

[Facial profile improving interventions using tissue expansion techniques].

If there is a lack of soft tissue in the face, no matter what the cause, the reconstruction should be performed using tissue from neighboring areas because tissue in the same aesthetic and functional area guarantees the best results. Two methods of dilation are described for such skin expansion explained by examples, and substantiated by statistics: (1) dilation with the aid of osteosynthesis plates; and (2) dilation with tissue expansion. To make an objective evaluation, only cases where considered that were finished 3 years ago.

Cephalometry↗
PubMed1993

Tissue expansion for the treatment of myelomeningocele. Case report.

A baby boy who had been born with a large myelomeningocele had a ventriculoperitoneal shunt inserted at the age of 6 months. Two months later it was revised, after which he developed satisfactorily both mentally and physically. He presented at the age of 13 months because the epithelialisation of the myelomeningocele was both fragile and incomplete. Enough soft tissue was obtained to cover the defect, which was 13 x 10 cm, by the use of two 600 ml expanders placed subcutaneously one on either side of the deformity.

Humans↗
PubMed1994

Reconstruction of midfacial defects following surgical management of skin cancer. The role of tissue expansion.

Compared with other locations on the face, skin cancer of the midface has a higher risk of recurrence owing, in part, to the mode of spread and the high frequency of subclinical extension. Skin cancers occurring in the region of the melolabial crease, nasal columella and medial canthus should be resected by Mohs surgery. Because tumors of the midface are sometimes recalcitrant, there are times when surgical ablation results in extensive defects. Reconstruction may be difficult owing to lack of available donor tissue, or because of previous surgery in the area of the proposed donor region. In these circumstances, tissue expansion in the form of controlled prolonged expansion or rapid intraoperative expansion, may, on occasion, provide the optimal reconstruction of form and function.

Aged↗
PubMed1993

[Forum on tissue expansion. Breast reconstruction by expansion in a young woman with sequelae of thoracic amniotic disease. Apropos of a case].

Amniotic disease or congenital skin sulci disease is a clinical entity covering a broad spectrum of malformations, usually involving the limbs, skull and face. This malformation is exceptional in the thorax. The authors report the case of a 22 year old woman with sequelae of thoracic amniotic disease, consisting of unilateral mammary aplasia, atrophy of the pectoralis major and latissimus dorsi muscles and deformity of the homolateral thoracic skeleton. They describe the breast reconstruction performed by tissue expansion in this patient.

Adult↗
PubMed2001

Tissue expansion of the lower limb: complications in a cohort of 103 cases.

Over 10 years we performed 103 skin-expansion procedures and placed 207 prostheses on lower limbs, using the same surgical protocol. In 83 cases (80.6%) the expansion was achieved without complications. We recorded 20 complications in all (19.4%). Major complications included sepsis, damage due to undermining, exposure of the prosthesis and necrosis of the flap in 16 cases (15.5%), resulting in complete failure of the method in five cases (4.9%). In all, nine patients had septic complications (8.7% of the patients and 45% of the complications), five had exposure of the prosthesis and two had skin necrosis after expansion. Infection and skin necrosis, which are the main causes of failure of this method, can be prevented by a strict surgical protocolcovering all stages of the procedure. Atraumatic undermining, remote and external valves, suction drains in the cavities, advancement flaps and plaster casts after surgery can help to prevent skin necrosis. A separate and remote approach for each prosthesis can prevent infection of all the prostheses and complete failure of the expansion procedure.

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↗
PubMed2001

Tissue expansion using osmotically active hydrogel systems for direct closure of the donor defect of the radial forearm flap.

Although widely used, the radial forearm flap has been criticized for the poor quality of its donor site. Attempts to avoid donor-site problems have concentrated on the elaboration of the split-thickness and full-thickness skin graft methods of reconstruction. Skin grafts frequently fail over the flexor carpi radialis tendon, leading to chronic skin breakdown or, at best, tendon adhesion. Tissue expansion appears to be a good alternative that allows the use of local tissues to ultimately improve the forearm donor-site appearance. To avoid the disadvantages of traditional silicone balloon expanders (such as pressure peaks, infection, the valve at a distance from the expander, postoperative fillings), an osmotically active system was used. In an 18-month prospective study, 10 osmotically active hydrogel tissue expanders were placed on the forearms of 10 patients. The radial forearm flap was performed for intraoral reconstruction after surgical resection of oral cavity malignancies. The study showed that, in nine out of 10 patients, the expanded skin achieved was sufficient to cover the donor site after raising the forearm flap. Additionally, the expansion-related swelling pressure was well tolerated by the patients, the cosmetic results were very satisfactory, and the incidence of complications was very low. By using osmotically active hydrogel tissue expanders, there is no postoperative filling and no risk of complications arising from defective balloon expanders, filling valves, or missing ports.

Adult↗
PubMed1993

[Forum on tissue expansion. Conclusion. How to master expansion...].

The author presents several reflections based on more than ten years of experience with skin expansion. In order to master expansion, a number of rules must be respected at each step of the procedure:--start by defining the treatment plan,--choose appropriate material,--apply the expander(s) according to a rigorous approach,--prevent and treat all complications,--ensure sufficient expansion to eradicate the entire lesion. The authors views are illustrated by particular clinical examples using expanded transposition flaps: treatment of extensive baldness, ear reconstruction, repair of major sequelae of thoraco-abdominal burns.

Alopecia↗
PubMed1986

Breast reconstruction by tissue expansion for congenital and burn deformities.

We have used tissue expanders to treat 10 patients with breast deformities, 2 the result of burns and 8 congenital in origin. The expanders are placed in the subglandular plane and expanded incrementally until the desired amount of growth is obtained. In patients with congenital deformities, the desired size of the reconstructed breast (implant size) is determined during the expansion phase. Reconstructions of the nipple-areola complex are done either at the time of the exchange or as separate procedures. Patients with burn deformities present a variety of problems not seen with the congenital deformities. The expander is placed in the subglandular plane and filled to the desired volume. We have noted a marked permanent softening of the scar and grafts encasing the breast, which persists after the expander is removed and the breast reconstructed. The interval between expansion and definitive reconstruction is delayed for several months to allow scar softening to take place. If the parenchyma is not burned and pedicle tissue is not required, the expander can be deflated and the skin coverage observed to determine if it will remain soft. If it does, the expander can be removed and the breast reconstructed. In patients who require pedicle coverage in the reconstruction and who have unburned scar surrounding the breast, massive overexpansion is carried out. The pedicle skin is used to resurface the breast after removal of the appropriate areas of scar and skin grafts. In all burned patients, the inframammary fold must be reconstructed if the breast is to be protuberant. The nipple-areola complex also requires reconstruction. To date there has been great acceptance by patients with both congenital and burn deformities; however, we believe that tissue expansion techniques offer possibilities that have not as yet been fully explored.

Adolescent↗
PubMed1993

Increased sensitivity in objective monitoring of tissue expansion.

The end point for incremental filling of any tissue expander normally may reliably be assessed using subjective parameters, especially pain, as a guideline. However, in unusual circumstances, such as within denervated areas, the presence of marginal skin circulation, or if rapid expansion is required, an objective monitor may be beneficial to ensure safer expansion. We have previously examined the role of serial measurement of transcutaneous oxygen in this regard. In an effort to refine this sometimes cumbersome approach, a comparison using laser Doppler flowmetry as well has been undertaken in 13 consecutive patients. Both monitoring devices demonstrated a progressive impediment to blood flow with increased expansion. At the pain threshold, both techniques recorded values consistent with adequate skin circulation, thereby proving in general the relative safety of subjective evaluation during the usual course of tissue expansion. Greater sensitivity was noted for the laser Doppler as a monitor, though, via the recording of earlier changes in flow characteristics and more rapid identification of critical thresholds for nonviability. From a more practical standpoint, immediate application without a period for equilibration is another major asset of laser Doppler flowmetry as a system for objective monitoring.

Adolescent↗
PubMed2005

Tissue expansion in management of failed phallic reconstruction: initial report of clinical series.

OBJECTIVES: To report the first significant experience with the use of tissue expanders in phallic reconstruction. Patients who have undergone multiple failed surgical procedures for repair of hypospadias or epispadias often have minimal residual skin available for additional reconstructive efforts. Although a variety of graft options exist, local skin expansion can provide pigment and texture-matched skin for reconstructive procedures. METHODS: We reviewed our experience with tissue expansion in patients after multiple failed phallic reconstructive efforts. A total of 18 males (mean age 13.2 years) with an underlying diagnosis of exstrophy/epispadias (n = 9), hypospadias (n = 7), partial androgen insensitivity syndrome (n = 1), and congenital adrenal hyperplasia (n = 1) had penile tissue expanders placed and inflated during a 6-week period. The expanders were removed at penile reconstruction. RESULTS: Tissue expanders were placed in 18 patients and successfully inflated in 17 patients. Good surgical results requiring no additional procedures were obtained in 8 (47%) of the 17 patients. Two patients subsequently underwent repeated tissue expansion; one of these patients had a good outcome after two expansions and supplemental pedicle graft, and the other had persistent fistulas and required a forearm graft. The implants were replaced because of extrusion in 3 patients and removed for malfunction, erosion, or infection in 1 patient each. CONCLUSIONS: The use of tissue expansion provides a useful option for reconstruction in patients with minimal or scarred skin after multiple failed prior phallic reconstructions and offers certain benefits over the transfer of free grafts. The availability of smaller tissue expanders makes this technique feasible even for young children.

Adolescent↗
PubMed2002

Identification of genes induced by rapid intraoperative tissue expansion in mouse skin.

A method of rapid skin stretching, i.e. hemispherical load cycling with an inflated subcutaneous silicone balloon (Rapid Intraoperative Tissue Expansion or RITE), permits the surgeon to rapidly elongate skin and create a flap of greater length for reconstructive plastic surgery. We have previously developed an experimental mouse model to evaluate RITE, and have shown that rapid stretching prevents ischemia and significantly reduces necrosis. Although the advantages of RITE have been demonstrated both clinically and experimentally, the cellular and molecular mechanisms underlying these benefits were unknown. In the study reported here, we used differential display reverse transcription polymerase chain reaction to identify genes that are specifically induced by RITE. Among four differential gene fragments, the expression of one was confirmed by Northern blot hybridization. The cDNA fragment was extended and the resultant sequence analyzed to reveal induction of truncated long interspersed nucleotide element 1 (LINE-1 or L1). Truncated L1 elements are located inside introns of many genes and among these genes myotubularin and insulin I are known to regulate cell growth. Northern hybridization using specific cDNA probes for myotubularin and insulin I demonstrated that it also was induced by RITE. This is the first reported study to show that L1, myotubularin and insulin I are responsive to rapid hemispherical and not rapid linear stretch.

Amino Acid Sequence↗
PubMed1998

Ureteral tissue expansion for bladder augmentation: a long-term prospective controlled trial in a porcine model.

PURPOSE: We recently described a technique that iatrogenically produces segmental megaureter while preserving renal function. In our initial report in 5 of 8 pigs that underwent this procedure bladder augmentation with the expanded ureter was successful. Throughout the expansion and reconstructive process renal function was preserved and all 5 animals that underwent augmentation had increased bladder capacity at sacrifice 1 month postoperatively. In the present study we evaluated the long-term durability and performance of the ureteral segment used for augmentation. MATERIALS AND METHODS: We performed a prospective, controlled, double armed study in 8 pigs, including 4 control animals that underwent subtotal cystectomy only (group 1) and 4 animals that underwent subtotal cystectomy followed by bladder augmentation using the expanded ureteral segment (group 2). End point measurements included cystography, and measurement of bladder capacity, serum creatinine and random bladder residual urine volumes. All cystograms were performed using passive filling conditions at a standard filling pressure of 32 cm. water. RESULTS: Bladder capacity throughout the study revealed consistently higher volumes in group 2 than in group 1. In 3 of the 4 group 1 subjects vesicoureteral reflux developed compared to no reflux in group 2. Creatinine levels were elevated at sacrifice in 50% of the animals in group 1 compared to none in group 2. Random bladder residual urine was less than 150 cc in 3 of the 4 group 2 subjects. CONCLUSIONS: Serial cystograms in pigs after ureteral augmentation suggest that the tissue does not contract with time. Animals that underwent ureteral augmentation had significantly greater bladder capacity than controls. Random bladder residual urine volume remained low throughout the study period. Ureteral tissue expansion for bladder augmentation appears to be feasible and durable in this animal model. In addition, it may be protective against the deleterious effects associated with small capacity bladders.

Animals↗
PubMed1997

The use of external tissue expansion in the management of wounds and ulcers.

A series of 43 wounds and ulcers in 37 patients were treated with the use of constant-tension approximation devices for periods ranging from 7 to 28 days. The etiologies of the lesions were diabetes; posttraumatic, including iatrogenic causes; neuropathic; pressure sores; and collagen disease. The approximation device is described and the technique of applying the device is detailed. The results are presented in tabulated form. The contraindications to the use of this methodology are discussed and the importance of patient selectivity is stressed. Evidence is presented to indicate that constant-tension approximation increases the healing rate as well as provides partial or complete full-thickness coverage, depending on the size of the wound. Such coverage reduces the recurrence rate and is usually only achieved by an operative approach, which is thus avoided. The socioeconomic advantages of this approach are mentioned.

Debridement↗
PubMed1991

A protocol for tissue expansion in upper extremity reconstruction.

Twenty tissue expanders were used in twelve patients for reconstruction of the upper extremity after trauma or burns with extensive soft tissue loss. A protocol, designed to avoid complications, included defects not exceeding thirty percent of the arm circumference, use of low-profile expanders, and slow expansion. Attention to these details avoided all complications except for transient neuropathies.

Adult↗