Complications in tissue expansion.
Appropriate patient selection, proper informed consent, and a calm and thoughtful approach to problems of implant deflation, infection, and exposure should prevent true "disasters" in tissue expansion.
Humans↗
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Results for “Tissue Expansion”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Postirradiation extensive cicatricial scalp alopecia treated by tissue expansion.
The scalp of a 20-year-old woman with extensive cicatricial alopecia caused by x-ray irradiation for tinea capitis has been reconstructed by the use of tissue expansion. Two stages were required to reconstruct the large defect. The hair-bearing posterior scalp has been expanded to cover the whole irradiated area, creating a new anterior hairline and a pleasing cosmetic result.
Adult↗
An early appraisal of the methods of tissue expansion and the transverse rectus abdominis musculocutaneous flap in reconstruction of the breast following mastectomy.
In a 2-year prospective study, the results of two methods of breast reconstruction were compared. The tissue expansion and implant method was found to offer an acceptable reconstruction, but it was associated with a high rate of complications and revisions. The transverse rectus abdominis musculocutaneous flap reconstruction provided a more satisfactory reconstruction, with fewer major complications as well as a higher degree of patient satisfaction and less patient dissatisfaction. The present study does not address the long-term results of either procedure.
Breast↗
Staged use of soft-tissue expansion and lower thoracic advancement flap in breast reconstruction.
A single patient is presented in whom breast reconstruction after mastectomy for breast cancer has been achieved by sequential use of soft-tissue expansion followed by permanent silicone implant placement and thoracic flap advancement to define the inframammary fold. This procedure may play a useful role in patients in whom other, more complex methods of breast reconstruction are not selected or indicated and in particular in patients in whom bilateral silicone implants are utilized.
Adult↗
Tissue expansion and flaps for surgical correction of male pattern baldness.
The author describes how to use a long, non-delayed temporo-parieto-occipital (TPO) flap across the total frontal hairline, and tissue expansion for coverage of the bald area behind the flap. This concept can be used successfully in extensively bald patients where two TPO flaps would not be sufficient to cover the total bald area. An even growth of hair is achieved. When the hair "reserve" is good, quite dense hair can be reconstructed. The flap described is performed under local anaesthesia without delays and does not have the risk of postauricular necrosis sometimes seen with certain designs of TPO flaps.
Adult↗
Continuous versus conventional tissue expansion.
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Humans↗
Tissue expansion and skin circulation. Simultaneous monitoring by laser Doppler flowmetry and transcutaneous oximetry.
The skin circulation was examined in nine patients during filling of their breast expander prostheses. Despite the high expansion pressure, which was increased above the systolic blood pressure, the overlying skin showed good circulation both clinically and when measured with a laser Doppler flowmeter and a transcutaneous oximeter. We conclude that the expansion was therefore directed to the tissues between the expander and the skin--that is, the fibrous capsule surrounding the prosthesis. Nine subcutaneous tissue expanders located in different anatomical regions were overfilled to a pressure at which all skin circulation ceased. Sufficient saline was then removed to allow skin circulation to return. Oxygenation of the skin ceased at a relatively low pressure when measured by transcutaneous oximetry, whereas when the skin circulation was measured with a laser Doppler flowmeter it did not disappear until the expander pressure had been raised appreciably above that level.
Adolescent↗
An occasion to revisit immediate tissue expansion.
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Humans↗
Repeated tissue expansion in reconstruction of a huge combined scalp-forehead avulsion injury.
A 29-year-old woman sustained a severe combined forehead-scalp avulsion injury (20 X 17 cm) in an automobile accident 4 years ago. The skull was covered with split skin-grafts. The defect was successfully removed by the use of simultaneous and repeated tissue expansion of the normal occipital area and the remains of the forehead. The case illustrates the possibility of using large expander volumes (1,700 cc) in the head area and the fact that even narrow skin bridges (2.0 cm above the left eyebrow) can be expanded. The expander shape can be chosen to create a desired flap size and form. Finally, hair thickness and growth can be quite acceptable even after huge expansions of the scalp.
Adult↗
Repair of thoracoabdominal ectopia cordis with myocutaneous flaps and intraoperative tissue expansion.
Thoracoabdominal ectopia cordis is a congenital malposition of the heart and abdominal viscera, which are externally situated, carrying an extremely poor prognosis. We report a case of a complete thoracoabdominal ectopia cordis that had undergone successful coverage over the exposed heart and abdominal contents. A few hours after birth, the defect was repaired with an expanded polytetrafluoroethylene soft-tissue patch that was gradually reduced by suture plication. Coverage was completed 48 hours later with bilateral pectoralis major and rectus abdominis myocutaneous flaps. Intraoperative tissue expansion minimized the cardiac compression produced by surgical reconstruction of the defect. Our patient, who is now 36 months old, represents the seventeenth case to survive reconstructive attempts.
Abdomen↗
Tissue expansion in cicatricial alopecia.
A surgical approach for the treatment of cicatricial alopecia may be considered when the causal component has resolved and hair replacement is desired. Traditional procedures have been limited to scalp reduction and hair transplantation. The advent of expandable silicone implants under adjacent normal hair-bearing skin for the creation of scalp flaps offers another approach for scalp reconstruction. Tissue-expansion augmented scalp reduction of cicatricial alopecia is a surgical procedure for some patients who might not otherwise be candidates for surgical hair replacement.
Adult↗
Tissue expansion in burn sequelae repair.
Burns may cause emotional, aesthetic and functional sequelae. Extended or hypertrophic scars are usually difficult to repair using local tissues, and the use of skin grafts may cause further injuries to the donor sites. The use of tissue expanders may offer a better option in the treatment of burn sequelae. This is a report on our experience using tissue expanders in 54 cases (23 patients) of burn sequelae located in different anatomical areas. Fourteen of the patients were female and nine male ranging in age between 5 and 48. The expanders were placed in the subgaleal, submuscular, subfascial or subcutaneous planes. Skin expansion was completed in 50 cases (92.5%). The injured area was removed by advancement flaps in 44 cases and by transposition flaps in 6 of them. Primary expansion was performed in 42 cases and reexpansion in 12. The rate of complications was 24.07%, of which 30.8% were considered to be absolute and 69.2% relative. Tissue expansion is an excellent option for burn sequelae treatment because it provides skin of similar local characteristics and does not damage the donor site. The procedure can be repeated in the event of major sequelae (reexpansion).
Adolescent↗
Tissue expansion for reconstruction of an unusual form of complex syndactyly.
Tissue expanders can be used over the dorsum of hand and fingers to increase available tissue for flap coverage after release of syndactyly. Herein, we presented an 18-year-old man who had an unusual complex syndactyly in the middle and ring fingers of his right hand. He had also complete fusion of the proximal phalanges. In this report, we described the application of tissue expander to cover separated exposed bones.
Adolescent↗
Some useful techniques for avoiding complications of tissue expansion.
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Humans↗
An improved model for tissue expansion and flap research in the rabbit.
A pocket for tissue expander implantation in the rabbit is described at the level between the skin and the panniculus carnosus. The vascular anatomy of the undermined skin was studied with microangiography which showed a functional (sub)dermal plexus. Expanders were placed in seven rabbits and inflated daily over a period of 10 days. Blood flow in expanded skin, as measured with laser Doppler flowmetry, dropped with increasing inflation pressure. During the course of expansion, the intraluminal pressure returned to a baseline level within 24 hours after each inflation. It is concluded that an expander placed in the described layer in the rabbit causes considerable skin stretch and interferes with cutaneous blood supply and is therefore an improved model for tissue expansion in the human.
Animals↗
The role of tissue expansion in abdominal wall reconstruction.
Abdominal wall reconstruction of ventral hernia defects with loss of visceral domain and inadequate soft-tissue coverage presents a surgical challenge. Four patients with large, skin grafted ventral hernia defects were treated by staged abdominal wall reconstruction. During the initial stage, tissue expanders were placed under the skin and subcutaneous tissue lateral to the defects. After adequate interval expansion, the second stage was performed. The expanders were removed, the visceral contents reduced easily, and the fascia reapproximated with polypropylene mesh. The expanded skin was closed easily over the fascial repair. All four patients were reconstructed successfully without complications. Tissue expansion can restore abdominal domain and allow soft-tissue closure in complicated ventral hernia defects.
Abdominal Muscles↗
Primary and secondary tissue expansion gives high quality skin and subcutaneous coverage in children with a large myelomeningocele and kyphosis.
When operating on a child with a large myelomeningocele and kyphosis, coverage with skin of high quality and a supporting layer of subcutaneous tissue can be difficult. The dermal circulation in the newborn is finite and an extensive mobilisation of the skin is a risky venture. Between 1988 and 2003 five children with large thoraco-lumbal myelomeningocele and kyphosis underwent subcutaneous insertion of silicon tissue expanders due to skin cover difficulties. In three children the skin surface was allowed to granulate over the myelomeningocele. In the other two children closure of the myelomeningocele was attempted but failed leading to secondary epithelialisation. Four of the children had two tissue expanders inserted at the age of 8-12 months; two of them before delayed operation for the myelomeningocele and two before elective spinal column surgery. The fifth child was nine years old when two tissue expanders were inserted before delayed myelomeningocele repair. Saline was injected into the expanders every 3-7 days during six to eight weeks. The expansion treatment was well tolerated. The result was an excellent skin and subcutaneous coverage in four of the children. For the fifth child who was the oldest and obese, one filling port was damaged during one of the injections, leading to insufficient tissue expansion. An extensive skin mobilisation was required and the result was not optimal. Tissue expansion is a simple, but a less known technique for acquiring good skin and subcutaneous coverage in children with large myelomeningocele and kyphosis. The expansion can be done either before delayed myelomeningocele repair or after failed primary operation thus eliminating the need for extensive musculo-cutaneous flaps.
Age Factors↗