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At least 37 records · Page 2Linked to original sources
PubMed2006

An axisymmetric computational model of skin expansion and growth.

Skin expansion is the principal technique used in plastic surgery to repair large cutaneous defects, typically after tumour removal, burn care, craniofacial surgery and post-mastectomy breast reconstruction. It allows a gain of new tissue by means of gradual expansion of a prosthesis, surgically implanted beneath the patient's skin. Nevertheless, wide clinical use is not supported by a deep quantitative knowledge of the phenomena occurring during the expansion. A finite element model of the skin expansion was developed to evaluate the stresses and the strains of the skin due to the expander inflation and validated by proper in vitro experiments; furthermore, a growth model based on the mechanical stimulus was implemented to estimate the skin area gain. The developed computational approach, composed of the skin expansion model interaction and the growth law, proved its validity to investigate skin expansion phenomena: its use suggests a new predictive tool to optimize clinical procedures and the expander devices' design.

Algorithms↗
PubMed2003

Simultaneous orbital expansion and intraoral distraction osteogenesis of upper and lower jaws in a patient with hemifacial microsomia.

BACKGROUND: Correction of a micro-orbit, caused by clinical anophthalmia is a very challenging task. In hemifacial microsomia a micro-orbit may be combined with hypoplasia of the malar and the ascending mandibular ramus. MATERIAL: A 5-year-old patient with hemifacial microsomia is described. Hypoplasia of the malar bone and the tilted occlusal plane were corrected by means of intraoral distraction osteogenesis in the upper jaw following precise simulation surgery on a 3D-model. At the same time, the ascending mandibular ramus was lengthened with a second distraction device and a spherical tissue expander was inserted into the hypoplastic orbit. RESULTS: The malar as well as upper and lower jaws were lengthened and positioned symmetrically. The orbital cavity was expanded to 79% of that of the healthy side. Following removal of the distraction devices, the expander was exchanged for a larger one and orbital expansion was continued until overcorrection of the orbit up to 118 percent was achieved. CONCLUSION: Orbital expansion is a minimally invasive method of enlarging the volume of the eye socket three-dimensionally. Intraorally activated buried distraction devices enable "growth" of the jaws making bone transplants avoidable in many cases. By combining both methods, complex malformations can be corrected simultaneously in children.

Child, Preschool↗
PubMed2000

Use of tissue expanders with external ports.

The high number of reconstructive dilemmas brought about by more aggressive treatment of congenital malformations and burns has created the need for large quantities of donor skin for local coverage. Tissue expansion with external ports has become part of the authors' surgical armamentarium. From January 1996 to November 1998 the authors placed 34 expanders in 28 patients to correct congenital malformations or burn sequelae. The average patient age at the time of operation was 6.3 years, the average time of expansion was 49 days, and minimal and maximal expansion volume was 60 and 600 cc respectively. Serial injection was carried out every 2 days until total expansion was achieved, and the expanded area was two to three times as wide as the recipient defect. No major complications occurred. The most serious complications of infection and erosion of tissue overlying the device occurred in 17.6% of patients. There are several advantages to this technique: less tissue dissection, painless injections, shorter operating time, and early detection of leaks. Lozano ST, Drucker MZ. Use of tissue expanders with external ports.

Adolescent↗
PubMed1999

Expansion of the human microphthalmic orbit.

OBJECTIVE: To determine the effects of long-term, incremental enlargement of an orbital tissue expander on bone and eyelid growth in microphthalmia. DESIGN: A prospective, noncomparative case series. PARTICIPANTS: Five consecutive patients with microphthalmos treated with orbital expansion were evaluated. INTERVENTION: A tissue expander was placed into the orbits of five children (age, 10 months-6 years) with unilateral microphthalmos and gradually enlarged by saline injections. MAIN OUTCOME MEASURE: The midorbital width of each patient was determined from axial computed tomographic scans before insertion of the device. The length of the normal and abnormal eyelid fissures was measured at surgery. The postexpansion dimensions of both the normal and microphthalmic orbits and the eyelids were remeasured when the expanders were removed. The residual deficits between the normal and the microphthalmic sides were expressed in percentages. RESULTS: Gradual inflation of the expander to a diameter of 22 mm reduced the average preoperative orbital dimension deficit of the group from 14.6% (range, 8%-25%) to 3.8% after surgery (range, 0.5%-6.3%). The average pre-expansion eyelid length deficit for the group was 17.5% (range, 12%-26%) compared to 2.3% (range, 0.0%-5.3%) after expansion. The average expansion period was 56.8 weeks (range, 20-100 weeks). Two outpatient surgical procedures were required in each patient. CONCLUSION: Incremental inflation of a tissue expander placed within the microphthalmic orbit induced sufficient osseous and eyelid growth to ameliorate the major stigmata of this syndrome in all patients treated.

Child↗
PubMed1994

Full-load expansion technique and preliminary clinical application.

For accelerating the inflation process of soft-tissue expansion, a continuous inflation protocol regarding pain as the criterion of overinflation, the full-load expansion technique, has been introduced. It is carried out by restricting persistently the pressure in the expander near the pain threshold in a state of dynamic equilibrium between the infusing rate and the skin expansion velocity with a simple and practical device. This inflation is neither at a uniform infusion rate nor at a constant filling pressure. Nineteen expanders in 13 patients were inflated following this protocol. Their inflations were fulfilled in 5 to 20 days, depending individually on their anatomic regions, total volumes of infusion, areas of the overlying skin, and patient susceptibilities.

Adult↗
PubMed2001

The fate of the fibrous capsule after saline implant removal.

After removal of a silicone breast implant, if a capsulectomy is not performed, the residual capsule may persist, become calcified, and appear on routine mammograms. The fate of the capsule around saline implants is less clear. The purpose of this study was to determine the fate of the capsule around saline-filled implants in an animal model. Rats were implanted with 6-ml tissue expanders, which were left in place for 4 months. The implants were then removed and the capsules around the injection port (smooth surface) and tissue expander (textured surface) were examined sequentially. The capsules contracted and dissipated gradually over a year in association with a pericapsular vascular proliferation. It may not be necessary to perform a capsulectomy at the time of saline implant removal.

Animals↗
PubMed1995

[The technical safety of tissue expander domes].

UNLABELLED: Since leakage of an expander dome is a well-known complication that may lead to interruption of a tissue expansion procedure, the aim of this project was to study different expansion domes in relation to a medication port after perforation with various needles. MATERIAL AND METHODS: The combinations of five different expansion domes and one medication port were tested with three different needle types having two different diameters. The force-distance curves during puncturing, the puncture forces required and the leakage opening pressures were measured after single on repeated punctures with small and large forces. A total of more than 2000 experiments were performed. RESULTS: Only one of the expander domes and the medication port had sufficient pressure stability. The technical characteristics of these devices are presented. However, the different needle types and puncture techniques had only a minor influence on the pressure stability of the expander domes.

Catheters, Indwelling↗
PubMed2000

New osmotically active hydrogel expander for enlargement of the contracted anophthalmic socket.

BACKGROUND: Clinical anophthalmia is characterized by the absence of an eyeball within the orbit and can result in overall growth retardation of the facial skeleton. The goal of treatment consists of fitting a serial prosthesis following rapid expansion of the contracted socket as soon as possible to achieve cosmetically acceptable eyelid and orbital symmetry. METHODS: Four children, aged 3-11 months, were treated by implantation of an anhydrous, highly hydrophilic tissue expander into the rudimentary conjunctival sac. With hydration of up to 98% in 72 h, the copolymer of methylmethacrylate and vinylpyrrolidone acts like an osmotically self-inducing socket expander. RESULTS: In the course of 2 months the previous contracted socket was enlarged, the horizontal lid length increased and the hydrated expander could be exchanged for a custom-made glass prosthesis. CONCLUSION: Preliminary results suggest that this new device can be used to avoid early plastic surgery of the eyelid. In addition, it also may enlarge the volume of the bony orbit.

Anophthalmos↗
PubMed2000

Pulsatile expansion therapy for orbital enlargement.

Experimental and clinical investigations have documented the modulatory role of the globe in the development of the orbit. In cases of absence or early loss of the globe, severe hypoplasia of the orbit and midface has been reported by several authors. Statical conformers and orbital osteotomies have been used to correct the resulting facial asymmetry. When replacing such conformers by increasingly larger ones, orbital structures are negatively influenced by the repeated trauma of surgical interventions. Simulating the modulatory role of the globe on orbital growth was the objective when developing a pulsatile device for orbital enlargement in cases of anophthalmia and microrbitism. The design, application and preliminary experience with a dynamic, pulsatile expanding system are presented.

Anophthalmos↗
PubMed2001

[Gradual wound closure by dermatotraction of the hand].

There are various treatments for skin defects. In our study we used a skin-stretching device for the closure of six skin defects of the hand and wrist (Sure-Closure System, Life Medical Sciences, Inc., Princeton, N.J.). Three defects were closed completely. The size of the other three wounds was reduced by 50 to 70%. We saw no complications. The skin-stretching device helped to close skin defects with local sensate tissue.

Adolescent↗
PubMed1997

Experience with a make-it-yourself scalp extender with hooks.

BACKGROUND: Silicone scalp extenders have been shown to facilitate the process of scalp reduction surgery. OBJECTIVE: This report demonstrates how scalp extender devices can easily be made in the physician's office out of materials that are commercially available. METHODS: A scalp extender is made by bonding a narrow strip of Dacron-reinforced Duralastic silicone sheeting to each end of a long strip of plain Duralastic silicone sheeting. A stainless steel plate of hooks is then secured to each end of the extender. At the time of the first standard scalp reduction surgery, one extender device about 3.0 x 5.0 cm is placed in the subgaleal plane, in the transauricular direction, with hooks piercing the galea 1 cm caudad to the dense-in-quantity hair fringe margin. The circumferencial approach will accommodate the placement of a second extender device in the anterior-posterior direction to elevate the posterior hair fringe. To prevent adhesion of the galea to the periosteum around the devices, a sheet of plain silicone 15 x 20 cm is placed over the periosteum before the extenders are inserted. The extenders are replaced with shorter devices 3-4 weeks later. RESULTS: Usually the average width of bald scalp can be closed fringe to fringe in three operations as compared with five or six operations when using standard scalp reduction procedures. CONCLUSIONS: The scalp extender device described can be custom made in many different sizes. Its use has significantly changed the author's surgical treatment of pattern alopecia.

Alopecia↗
PubMed1994

Decrease in skin-closing tension intraoperatively with suture tension adjustment reel, balloon expansion, and undermining.

BACKGROUND: The biomechanical and viscoelastic properties of the skin enable it to be significantly stretched within a relatively short period of time. This property, called mechanical creep, is exploited in various surgical maneuvers for intraoperative closure of large surgical defects. The recently introduced Miami Suture Tension Adjustment Reel (S.T.A.R.) device permits both the precise sutured attachment of a linear cycled load to approximate the edges of widened surgical defects, and the easy measurement of wound edge tension across the defects. OBJECTIVE: It was our purpose to compare the relative effects of linear load cycling with the S.T.A.R. device, spherical load cycling with balloon expander, and surgical undermining on the closing tension of surgical defects. METHOD: Surgical wounds were created on the flanks of six pigs and these defects were closed by various methods of repair. The combination of undermining and the S.T.A.R. device ws also evaluated. RESULTS: The average total decreases in skin closing tension were: undermining, 17.8 +/- 0.5%; balloon, 28.5 +/- 1.6%; S.T.A.R. device, 36.6 +/- 4.8%. CONCLUSION: Our data showed that all three techniques were effective in lowering the tension required to approximate surgically created defects, with the S.T.A.R. device proving to be most effective. Undermining and the S.T.A.R. device also worked synergistically to decrease skin-closing tension.

Animals↗
PubMed2001

Infusion port dislodgement of bilateral breast tissue expanders after MRI.

Tissue expanders are placed routinely for breast reconstruction, and magnetic resonance imaging (MRI) is a common diagnostic procedure. Many studies have reported on the safety of MRI in patients with nonferromagnetic implants; however, many tissue expanders contain ferromagnetic components. The authors present a case of bilateral tissue expander infusion port dislodgment after MRI. A 56-year-old woman underwent bilateral mastectomy and immediate reconstruction with McGhan BIOSPAN tissue expanders. These implants contain integral nonferromagnetic infusion ports, as well as small, powerful Magna-Site magnets. Several weeks postoperatively the patient underwent MRI of her spine, which was ordered by her primary physician for back pain. Subsequently, the infusion ports could not be located with the finder magnet. A chest radiograph was obtained, which demonstrated bilateral dislodgment of the infusion ports. Surgical removal and replacement of the tissue expanders were required. Safety considerations of MRI have been discussed extensively in the literature, and data on MRI with various implanted devices have been obtained. The potential risks of performing MRI on patients with metallic implants include conduction of electrical currents, heating of the implant, misinterpretation resulting from artifact, and the possibility of movement or dislodgment of the implant. The small magnet integral to many tissue expanders may be overlooked by patients and physicians during pre-MRI screening. All patients undergoing tissue expansion with implants that contain integral ports should be thoroughly warned about the potential hazards of MRI.

Breast Neoplasms↗
PubMed1996

An intraoperative skin-stretching device to close wounds in Mohs defects.

BACKGROUND: A skin-stretching device takes advantage of the viscoelastic properties of the skin by exerting incremental traction to aid in closing complex wounds. OBJECTIVE: To evaluate the effectiveness of a skin-stretching device and determine the cosmetic results available when this device is used in Mohs surgery. METHODS: We applied a skin-stretching device to seven patients, each of whom had a large, complex wound defect following Mohs surgery. All of the patients had basal cell carcinomas. In one patient the carcinoma was on an upper extremity, and in the others the carcinoma was located on broad facial surfaces, including the temple and forehead. RESULTS: Complete primary closure was accomplished in six patients. A maximum of three cycles of tissue stretching were applied during the period of tissue processing between Mohs layers. In one patient the defect was reduced in size by more than 75%, with final healing by secondary intention. In two patients minor complications developed: focal wound dehiscence occurred in one patient and in the second patient, an inconsequential hypertropic scar developed. In both cases, the problems resolved with acceptable cosmetic results. The remaining patients experienced no complications and the cosmetic results were excellent. CONCLUSION: The skin-stretching device accomplishes effective primary closure of large skin defects by dramatically reducing the size of the defect. It allows a simpler closure where a full-thickness graft or local flap would have otherwise been utilized. The device is convenient to use with minimal complications, reduces operative time, and aids greatly in preserving tissue integrity.

Aged↗
PubMed1993

A method for detection of a punctured saline tissue expander.

Inadvertent puncture of a tissue expander from a needle can occur both intraoperatively and postoperatively. With a small puncture hole and a partially filled expander, detection of the hole can be very difficult, especially in the postoperative period when removal of the entire device may become necessary for adequate examination. A simple method is described to detect the presence of such a leak with the use of fluorescein dye.

Adult↗
PubMed2006

Enterogenesis in a clinically feasible model of mechanical small-bowel lengthening.

BACKGROUND: Recent work indicates that mechanical force induces small-bowel growth, although methods reported do not have direct clinical application. We report a clinically feasible technique of enterogenesis and describe intestinal function in this model. METHODS: Using a pig model (n = 11), we stretched isolated small intestinal segments mechanically for 7 days in vivo with an intraluminal device. Control segments were not stretched. Morphology, histology, and epithelial proliferation were assessed. Absorption and epithelial barrier function were examined in an Ussing chamber. RESULTS: Stretch segments were significantly longer than Control segments and had nearly 2-fold greater surface area (P < .001). Mucosal thickness was much greater in Stretch than Control segments (772 +/- 134 vs. 647 +/- 75 microm, P = .02). Although villus height was reduced in Stretch and Control segments (353 +/- 76 vs. 324 +/- 76 microm, P = .6) versus native jejunum (522 +/- 87, P < .0005), crypt depth was increased dramatically in Stretch (450 +/- 95 microm) versus Control segments (341 +/- 64, P = .005). This observation was accompanied by a 2-fold increase in cellular proliferation (26.3 +/- 3.8 vs 12.1 +/- 6.6 % bromodeoxyuridine+, P < .05). Barrier function was intact ([3H]-mannitol permeation, 0.16 +/- 0.08%, vs native jejunum, 0.17 +/- 0.08%, P = .81). Glucose-mediated sodium transport was similar in Stretch versus native jejunum segments (60.0 +/- 23.5 vs 82.3 +/- 47.3 microA/cm2, P = .31), as was carbachol-induced chloride transport (82.4 +/- 72.2 vs 57.2 +/- 33.4 microA/cm2, P = .54) and alanine absorption (16.46 +/- 12.94 vs 23.53 +/- 21.31 microA/cm2, P = .53). CONCLUSIONS: Mechanical stretching induces small intestinal growth, while maintaining function. Epithelial architecture does change, such that a decrease in villus height is offset by a marked increase in crypt depth and a 2-fold increase in epithelial proliferation. Epithelial barrier and absorptive functions remain intact. The device described may have direct clinical applicability.

Animals↗
PubMed1999

[Application of skin-stretching devices in reparative and reconstructive surgery].

OBJECTIVE: To testify the availability and the clinical efficacy of the skin-stretching device. METHODS: The skin-stretching device designed by ZHOU Li-an, which was used in the treatment of the granulation wound, the donor site of flap, and the skin defect after the excision of tumor by skin traction technique at the wound edges. RESULTS: The usage time of skin-stretching device was 15-720 minutes, it could be used preoperatively, intraoperatively and postoperatively. Followed up 16 cases for 6 to 12 months, the device was effective. CONCLUSION: The skin stretching device is practical and effective in wound closure of skin defect.

Adolescent↗