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At least 343 records · Page 19Linked to original sources
PubMed1996

Is there liability with chemotherapy following immediate breast construction?

Review of 46 consecutive patients undergoing immediate breast reconstruction with tissue expanders and subsequent implant placement was conducted to assess the potential liability of adjuvant chemotherapy. Twenty-three patients required chemotherapy, while 23 did not. Critical comparison of complications and outcome of the two groups revealed no significant differences. Within the parameters of the study (avoidance of expansion or surgery during the period of chemotherapy), there appeared to be no disadvantage posed to the immediate reconstruction patient by adjuvant chemotherapy. We feel that this option can continue to be offered despite the anticipation of probable chemotherapy.

Breast Implants↗
PubMed1996

Tissue expansion: a method to preserve bone length and joints following traumatic amputations of the leg--a follow-up of five legs amputated at different levels.

Tissue expansion of adjacent intact skin and subcutaneous tissue has in five legs provided high-quality soft-tissue coverage of the distal end in legs amputated at different levels without further shortening of the bone. The sensitivity of slowly expanded flaps is temporarily affected but eventually seems to return to normal. Expanded flaps have endured both sitting and the use of prostheses for 4 to 5 years. In one case the technique made it possible to save the knee joint. Besides being a functional reconstruction, the appearance of the reconstructed parts much improved. A technique of overexpansion and double flap coverage of the bone utilizing deepithelialization is described.

Adolescent↗
PubMed1996

Research on soft-tissue expander permeability to metronidazole and procaine.

This in vitro study was designed to determine if in fact silicone expanders are readily permeable to metronidazole and procaine. The expanders were filled with 0.2% metronidazole or 2% procaine through the filler valves and then immersed wholly in normal saline. At several intervals over 120 hours, a certain amount of the surrounding saline was sampled and the drug levels subsequently determined. In this study, the silicone expanders were indeed readily permeable to the drugs, as measured with an ultraviolet spectrophotometer. A consistent diffusion curve was demonstrated. The rate of diffusion of a drug is inversely proportional to its molecular weight; i.e., the smaller the given drug's molecular weight, the greater is its ability to permeate an expander. In view of this, in the course of expansion, 0.2% metronidazole could be used in clinical expansion instead of normal saline, and a certain amount of antibiotic would diffuse out of the expander to prevent and control the infection.

Humans↗
PubMed1997

Low capsular contraction rate after primary and secondary breast reconstruction with a textured expander prosthesis.

The expander prosthesis has the advantage over the temporary expander of being permanent and thus does not require an operation when the implant has to be exchanged for a permanent prosthesis. Forty-nine women who had had either primary or secondary breast reconstruction performed with a permanent textured expander prosthesis were included in the study. No patient in either group had received radiotherapy. Breast softness was evaluated by an objective method, applanation tonometry, when saline was extracted from the implant to the desired breast volume after 3 months of slight overexpansion. Follow-up examinations were done 6 and 12 months later. In both groups the breasts became harder between the extraction of saline and the 6-month follow-up but then remained unchanged at the 12-month checkup. The capsular contracture rate after 6 months was 11 percent in the primary breast reconstruction group (n = 37) and 0 percent in the secondary breast reconstruction group (n = 11). After 12 months, the results were constant. There was no statistically significant difference between the two groups at any time. The low capsular contracture rate in both groups shows the suitability of the expander prosthesis for achieving good results in both primary and secondary breast reconstruction. Objective evaluation of the results in order to compare different materials and methods of breast reconstruction should be mandatory.

Breast Implants↗
PubMed1997

Two-dimensional cephalometric analysis of the effects of subperiosteal palatal soft-tissue expansion in growing cats.

The feasibility and possible effects of palatal soft-tissue expansion in palatal repair were studied. A prospective longitudinal animal experiment was performed in 75 growing cats assigned to 5 groups. In 31 cats, a midline defect was made, and bipediced flaps were raised at the age of 8 weeks (stimulated Langenbeck operation) in order to create palatal scars. At the age of 14 weeks, custom-made tissue expanders were inserted palatally in 61 animals. Tissue expansion was performed by weekly inflation in 33 cats (16 without and 17 with scars) for an 8-week period. The remaining 28 cats (14 without and 14 with scars) served as sham groups. A control group was formed by 14 animals (without scars and without tissue expanders). Soft-tissue gain and its effects on maxillofacial growth and development were measured in the midsagittal plane on tracings from standardized lateral radiographs. The effects of the experimental interventions were evaluated for 8 weeks after removal of the tissue expanders. Not all the cats yielded results at all time periods. This study showed that soft-tissue expansion of palatal mucoperiosteum is feasible. The surgically induced scars did not cause significant differences between the different groups in the midsagittal plane, and the data from both expansion and sham groups could be pooled. Significant soft-tissue gain was achieved by the tissue-expansion technique. Iatrogenic side effects were significant anteroposterior growth retardation at the level of the bony palate and an increase in vertical growth of the anterior nasomaxillary height and the posterior skull height during active tissue expansion. After removal of the tissue expanders, some accelerated growth was found in the tissue expansion in the scarred tissue group, with initial correction of the abnormal growth at the cranial base level. It is concluded that palatal soft-tissue expansion is possible in growing cats. This technique, however, impaired maxillofacial growth and development.

Analysis of Variance↗
PubMed1997

A case of popliteal pterygium treated along with nerve expansion.

The presence of a short sciatic nerve in the free edge of a popliteal pterygium makes this syndrome a surgical challenge. We present a case of popliteal pterygium that was treated by nerve expansion. The range of motion of the patient's knee joint was between 30 and 120 degrees. A 75-cc tissue expander was placed under the sciatic nerve and filled with 5 cc of saline solution weekly. When a total of 60 cc was reached, wound dehiscence was observed, and the procedure had to be stopped. The maximum extension obtained was 160 degrees. Since the expansion process had to be stopped early, the elongation attained by expansion was less than expected. We conclude that the nerve expansion method can be used as a good alternative treatment modality for patients with popliteal pterygium.

Child, Preschool↗
PubMed1997

Sideburn reconstruction with an expanded supraauricular trapezoidal flap.

Although loss of the sideburn and temporal scalp with subsequent alopecia is relatively frequent as a consequence of traumatic, surgical, and iatrogenic processes, not many techniques of sideburn reconstruction have been reported. We present a two-stage technique to correct the long-sideburns when there is an associated temporal alopecic defect due to trauma or surgery by means of an expanded supra-auricular trapezoidal flap. The method can achieve not only a satisfactory appearance of the sideburn but also a normal capillary line from the occipital to the frontal region.

Alopecia↗
PubMed1998

Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders and breast implants: a retrospective review of 171 consecutive breast reconstructions from 1989 to 1996.

A 7-year experience with 171 consecutive immediate breast reconstructions by one surgeon using a textured integrated-valve tissue expander was reviewed. All patients were reconstructed in multiple stages using a temporary biodimensional tissue expander followed months later by a long term implant. There was one (0.6 percent) spontaneous expander deflation that was replaced. Two (1.2 percent) expanders were removed for infection, and one was removed electively. Fourteen patients (8 percent) had flaps as well as expanders. Initially, expanders were replaced with silicone gel-filled and round saline-filled implants. Later, expanders were replaced mostly with anatomically designed textured saline-filled implants. Of the 171 expanders, 139 were thus ultimately followed by such anatomic designs. Seven (4 percent) of the implants were replaced because of deflation over 7 years. Five patients were lost to follow-up during the expansion phase of their reconstruction. Thirteen percent of these reconstructions received local radiation either before, during, or after expansion. There were a total of five (2.9 percent) significant capsular contractures, with four of them occurring in radiated patients. Ninety-eight percent of a subgroup of 42 consecutively queried patients expressed satisfaction with their reconstruction, while only 2 percent of the queried patients were dissatisfied.

Breast Implants↗
PubMed1998

Nipple-sparing total mastectomy of large breasts: the role of tissue expansion.

Nipple-sparing total mastectomy remains an alternative for management of patients with high risk breast disease or patients with various types of symptomatic breast problems. In a patient with large breasts, however, achieving good cosmesis while still performing a thorough mastectomy remains a challenge. This report includes 10 patients who underwent unilateral nipple-sparing total mastectomy and 10 patients who underwent bilateral nipple-sparing total mastectomy. Tissue expansion was used as the reconstructive technique in this consecutive series done from 1985 through 1988. All expanders were placed in the submuscular position, and hyperbaric oxygen was used when intraoperative fluorescein administration identified marginally perfused areas. The average volume of breast tissue removed was 800 gm. The average permanent implant size was 767 cc. Complications included partial skin or nipple loss, infection, and problems related to the implants themselves. The complication rate, however, was not excessive, and results have been good as measured by cosmetic results, capsule grade, and lack of development of cancer in operated breasts. This reconstructive technique is recommended as an alternative in those patients undergoing nipple-sparing total mastectomy.

Adult↗
PubMed1998

Long-term advantages of permanent expandable implants in breast aesthetic surgery.

Permanent expandable implants are widely used in breast reconstructive surgery, but their use in aesthetic surgery is still uncommon. Previous reports on breast expansion-augmentation using permanent expandable implants focused on immediate and early advantages but failed to evaluate long-term benefits, because the reservoir was removed a few months after implantation and the ability to adjust the implant size was lost. Since 1986, we have used permanent expandable implants in 129 women for unilateral or bilateral breast augmentation using the following approach: implants were positioned submuscularly through a transaxillary incision; the filling port was placed a few centimeters below the incision and permanently retained; the implants were positioned underinflated and then overexpanded starting 2 weeks after implantation; after a period of overinflation, deflation to the preoperatively planned volume was scheduled; patients' suggestions regarding final volume adjustments were followed; the effects of repeated overinflations and deflations were investigated in several different conditions. Permanent expandable implants offer unique long-term technical and psychological advantages in the management of highly demanding patients and in the following clinical situations: pregnancy, impending capsular contracture, contralateral progressive ptosis, tubular breasts(s), difficult mammographic examination, spontaneous deflation, and rippling. Disadvantages include economical cost, port-related problems, and repeated requests by patients for volume changes. Saline permanent expandable implants allowed less flexibility in adjusting the breast size and caused discomfort when overexpanded. Permanent expandable implants in breast aesthetic surgery offer several advantages, and because patients can play an active role in deciding volume adjustments, compliance is very high.

Adolescent↗
PubMed1998

Tissue expander complications in the pediatric burn patient.

Tissue expanders have become a useful adjuvant in pediatric burn reconstruction. We reviewed our experience with tissue expanders from June of 1984 to July of 1995. There were 403 expanders used in 301 patients. Complications relative to specific anatomic areas from July of 1987 to July of 1995 were compared with previously published data in the journal from June of 1984 to June of 1987. Complications were defined as absolute if they resulted in the loss of expanders or in additional surgery, or none of the preoperative plan was satisfied. The relative complications were defined as spotty alopecia, alopecia greater than 50 percent, or the operative plan was only partially satisfied, sometimes implying poor surgical judgment. The overall complication rate for the period June of 1984 to June of 1987 was 30 percent (37 complications in 122 expanders). In the July of 1987 to July of 1995 study, the complication rate was only 18 percent (51 complications in 281 expanders). This was a statistically significant decrease between the periods (p = 0.010). In the recent 8-year period, there was a decrease compared with the previous study in both the absolute and relative complications. The most common absolute complication in this period was infection (15 of 31, 48 percent) with 12 (39 percent) being early infection. With regard to the nine complications in the neck, face, ear, and supraclavicular area, two-thirds were related to leakage or exposure of the expanders, resulting from the tight anatomic area causing mechanical damage of the expanders as well as ischemia to the overlying skin. Early in the study, the lower extremities proved to involve difficult or unsatisfactory areas to expand, and lower extremity expansion was abandoned throughout the remainder of the study period. The overall decrease in absolute and relative complications is likely the result of increased operative experience as well as a developed protocol for the prevention of perioperative complications relating to infection and expansion in high-risk anatomic sites.

Burns↗
PubMed1999

The direct effect of intraorbital pressure on orbital growth in the anophthalmic piglet.

Tissue expanders placed within the orbit can have a positive effect on orbital and ipsilateral midfacial growth. To date, there is no precise method for controlling and monitoring expansion to induce normal growth in the developing facial skeleton. The present study was undertaken to determine the optimal physiologic pressure required to stimulate normal orbital growth and to determine whether above-normal growth could be achieved with higher intraorbital pressures. Using a neonatal swine model, an accurate method of monitoring intraorbital pressure, precisely controlling intraorbital expansion, and achieving normal orbital growth was explored. Sixteen male, 3-week-old Yorkshire piglets were randomly divided into three surgical groups. In each group, the left orbit was the experimental side, and the contralateral right orbit served as an untreated control. Group 1 (n = 6) underwent enucleation only. Group 2 (n = 5) underwent enucleation and orbital expansion at a near-normal physiologic pressure of 20 mmHg. Group 3 (n = 5) underwent enucleation and orbital expansion at a supernormal pressure of 60 mmHg. Spherical tissue expanders (10 cc) with a separate injection port were utilized as the orbital expanders. Pressure was monitored by an electronic manometer that was calibrated daily. Morphology of the orbits was documented by photography, the dimensions of the orbits were quantitated by three-dimensional mechanical digitization, and orbital volumes were calculated. In the unexpanded, anophthalmic control group, a significant reduction in radial growth after evisceration was seen. In group 2, the orbit stimulated with a consistent pressure of 20 mmHg, just above the physiologic normal pressure of 17 mmHg, showed an increase in radial dimension of 8 percent compared with the unoperated side. In the high-pressure group of 60 mmHg, an increase of 16 percent in the radius was observed over the 4-week period. This led to a corresponding increase in orbital volumes with increased pressure. Utilizing a paired t test, these differences in the radial and volumetric growth of the orbit were statistically significant (p < 0.005). The results obtained demonstrated a direct relationship between intraorbital pressure and the growth of the bony orbit in the radial dimension. On the basis of this study, we concluded that orbital expansion maintained at normal physiologic pressure can stimulate normal orbital growth in the neonatal facial skeleton. In addition, application of above-normal pressures for expansion can induce accelerated orbital growth.

Animals↗
PubMed1999

The premature removal of tissue expanders in breast reconstruction.

The role of tissue expanders in breast reconstruction is well established. Little information exists, however, regarding the incidence and etiology of premature removal of the tissue expander before planned exchange to a permanent breast implant. The purpose of this study was to review our 10-year experience with tissue expander breast reconstruction and identify factors relating to the premature removal of the tissue expander. This study is a retrospective review of 770 consecutive patients who underwent breast reconstruction with tissue expanders over the past 10 years. Breast reconstruction was immediate in 90 percent of patients. Patients were expanded weekly, and adjuvant chemotherapy was begun during the expansion process when required. Factors potentially affecting premature expander removal (chemotherapy, diabetes, obesity, radiation therapy, and smoking) were evaluated. Fourteen patients (1.8 percent) with a mean age of 47 years (range, 38 to 62 years) required premature removal of their tissue expander. Expanders were removed a mean of 3.2 months (0.1 to 8 months) after insertion. Causes for premature removal of the tissue expander included infection (7 patients), exposure (2), skin necrosis (2), patient dissatisfaction (2), and persistent breast cancer (1). Positive wound cultures were obtained in four of the seven infected patients (57 percent), requiring expander removal for infection. Tissue expanders were removed in 11 patients for complications directly related to the expander. Among these, six (55 percent) were receiving adjuvant chemotherapy, and one was a smoker. Diabetes, obesity, other concomitant medical illnesses, and prior mantle irradiation were not associated with expander removal. Premature removal of the tissue expander was required in only 1.8 percent of the patients in this series. Infection was the most common complication necessitating an unplanned surgical procedure to remove the expander. This study demonstrates that the use of tissue expanders in breast reconstruction is reliable, with the vast majority of patients completing the expansion process.

Adult↗
PubMed2000

Prefabricated (expander) capsule-lined transposition and advancement flaps in reconstruction of lower eyelid and oral defects: an experimental study.

In six pigs with prefabricated transposition flaps and six pigs with prefabricated advancement flaps, both flap types (lined with an expander capsule) were used to reconstruct wedge excisions of the lower eyelid or defects in the cheek/oral mucosa. The capsules replaced the conjunctiva in eyelid defects and the oral mucosa in cheek defects. Histopathologic studies were performed at 5 to 7 days, 9 to 10 days, 2 weeks, 3 to 4 weeks, and 2 and 3 months after flap reconstructions. Healing was rapid and uneventful, leading to restoration of the conjunctiva/eyelid and oral mucosa between 9 days and 2 weeks. The healing of the eyelid conjunctiva was somewhat faster than of the oral mucosa. The expander capsule acted as a conjunctival/ mucosal substitute, providing a temporary physical shield, an infectious barrier, and a matrix for epithelial regeneration. All reconstructions were successful except one oral reconstruction with early flap necrosis. Flaps lined with an expander capsule could improve and facilitate clinical reconstructions in the eyelid and oral cavity.

Animals↗
PubMed2000

Complex facial nevi: a surgical algorithm.

Sixty-six children with large congenital nevi of the face were surgically managed in our center during the last 8 years. All patients with a lesion that posed a reconstructive challenge were included in the study. None could be effectively dealt with by excision and simple primary closure. To simplify description and evaluation, the patients were divided into three groups. Group I had 15 patients with relatively small lesions (1- to 3-cm maximal diameter) that were confined to one aesthetic unit of the face and could be reconstructed in one stage. Reconstruction was usually achieved by using local skin flaps or with full-thickness skin grafting. Group II had 28 patients with medium-sized lesions (3- to 12-cm maximal diameter) that involved one or two aesthetic units and required not more than two stages for reconstruction. These patients usually needed either serial excisions and/or skin grafting or a two-stage tissue expansion procedure (insertion of tissue expanders and reconstruction). Group III had 23 patients with very large lesions (over 12 cm in maximal diameter), some covering half of the face and thus involving several aesthetic units and requiring multiple stages for reconstruction. These patients required a combination of tissue expansion procedures, large faciocervical and scalp/forehead skin flaps, full-thickness skin grafting, and serial excisions for reconstruction. The anatomic distribution of the lesions over the various aesthetic units is described, as are the reconstructive techniques with advantages and disadvantages of each, reflecting on outcome. The approach to the larger complex lesions is detailed. Based on our experience, a reconstructive algorithm is proposed.

Adolescent↗