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PubMed1992

Current status of tissue expanders in alveolar ridge augmentation: a review.

The need for major surgery involving bone and skin grafting procedures in the treatment of severe alveolar atrophy has, for many patients, been obviated by the advent of reliable endosseous implant systems. However, some patients, usually for medical, psychological, or financial reasons are unsuitable for endosseous implant therapy. In such patients, ridge augmentation with particulate hydroxyapatite may result in significantly improved denture function. However, hydroxyapatite tends to disseminate throughout any surgically created subperiosteal space, resulting in an undesirable ridge form. This problem may be overcome by the use of tissue expanders in a two-stage surgical procedure. This article briefly reviews the concept of tissue expansion and describes its application to the technique of alveolar ridge augmentation.

Alveolar Ridge Augmentation↗
PubMed2004

Management of the anophthalmic socket in pediatric patients.

PURPOSE OF REVIEW: The management of the pediatric anophthalmic socket is distinguished from adult anophthalmia, because normal socket and facial development is dependent on orbital growth. Recent literature on managing anophthalmic sockets is discussed with a focus on the pediatric patient. RECENT FINDINGS: There are many studies discussing the management of the anophthalmic socket, but few are randomized clinical studies. Although the management of anophthalmia in the child is fraught with challenges and nuances, the principal aim is to encourage socket growth. SUMMARY: Both congenital and acquired pediatric anophthalmia are discussed. Surgical decisions, choice of orbital implants, various methods of socket expansion, and socket reconstructions are examined.

Anophthalmos↗
PubMed2004

Use of self-expanding, hydrophilic osmotic expanders (hydrogel) in the reconstruction of congenital clinical anophthalmos.

PURPOSE OF REVIEW: Rehabilitation of the congenitally anophthalmic orbit is frustrating to both the parents and physician. Traditional methods involve using progressively enlarging static acrylic conformers to expand the conjunctival socket, followed by placement of conventional static spherical orbital implants, dermis-fat grafts, or inflatable balloon expanders for orbital enlargement. Limitations of these methods typically result in less-than-optimal cosmetic outcomes, with retardation of bony orbital and overlying soft tissue growth adversely affecting midfacial growth and symmetry. Recent advances in tissue expansion technology may offer additional, novel alternatives to conventional therapies. RECENT FINDINGS: Hydrogel tissue expanders were recently adapted for use in congenital anophthalmia. The expanders are placed in their dry, contracted states, and expand gradually to their full size via osmosis of surrounding tissue fluid, with up to a 10-fold increase in volume. Offering the benefit of predictable and controllable self-expansion, hydrogel expanders may offer yet another alternative or adjunctive therapy to the early rehabilitation of the contracted socket. Separate appliances are used for conjunctival and orbital reconstruction. Initial results appear promising. Tempering the enthusiasm for their use, however-particularly in terms of implanted orbital expanders-is the recent spate of long-term complications reported from previous uses of hydrogels as scleral buckling material. SUMMARY: Self-expanding hydrogel tissue expanders appear to offer an intriguing reconstructive alternative to the frustrating condition of congenital anophthalmia. Long-term safety of the material as an orbital implant has not yet been demonstrated, but early results are promising.

Anophthalmos↗
PubMed2003

Immediate breast reconstruction using biodimensional anatomical permanent expander implants: a prospective analysis of outcome and patient satisfaction.

Immediate breast reconstruction is offered to the majority of women requiring a mastectomy for cancer treatment. Improvements in implant technology have seen the evolution of shaped, fixed-volume implants and permanent expanders. The theoretical benefits of biodimensional anatomical expander implants include better reconstructed breast form, the potential for achieving this at a single procedure, and the avoidance of a contralateral procedure as a result of improved ipsilateral cosmesis. The aim of the present study was to assess outcome after immediate breast reconstruction using the McGhan 150 permanent expander implant. A total of 107 consecutive patients (129 breast reconstructions) were studied over a 30-month period; 49 patients (68 reconstructions) had submuscular implant placement alone, and 58 patients (61 reconstructions) had an implant in conjunction with a latissimus dorsi flap. The mean patient age was 47 years (range, 22 to 72 years) and the mean follow-up was 18 months (range, 6 to 40 months). Outcome was assessed in the following four ways: geometric measurements, evaluation of photographs by four independent observers, linear numerical analogue scale, and a quality-of-life questionnaire. Geometric measurements after surgery showed median differences that were highly consistent with good symmetry. Transverse breast width difference between breasts was 0.35 cm, vertical breast height difference was 0.8 cm, sternal notch-to-nipple distance difference was 0.6 cm, midclavicular line-to-nipple distance difference was 0.5 cm, nipple-to-inframammary crease distance difference was 0.5 cm, midline-to-nipple distance difference was 0 cm, and projection difference was 0 cm. Photographic assessment by four observers who evaluated shape, cleavage, symmetry, and overall outcome produced correlation values of 0.73 to 0.81. More than 75 percent of each of these parameters was scored as good or excellent. A numerical analogue scale (from 1 to 10) assessing overall result by the surgeon and patient revealed good (7 to 8) or excellent (9 to 10) scores in 83 and 82 percent of respondents, respectively. Quality-of-life data showed that 81 and 88 percent of women felt "a little" or "not at all" less feminine, respectively, and 88 percent were satisfied with the appearance of their breasts. A total of 88 percent of women would also choose the same reconstructive procedure if faced with the same cancer diagnosis. Complication rates were low; infections occurred in 6.2 percent of reconstructions, hematoma occurred in 1.6 percent, and implant loss occurred in 3.9 percent. Only 24 of 107 patients (22 percent) elected to have a synchronous contralateral breast adjustment, and four of 107 (4 percent) chose to have a subsequent procedure for symmetry. Biodimensional expander implants used in immediate breast reconstruction are associated with high levels of patient and surgeon satisfaction. Optimum breast form can be achieved during a single operation with a low incidence of complications.

Adult↗
PubMed2003

Salvage of infected expander prostheses in breast reconstruction.

Periprosthetic infection is a devastating complication following breast reconstruction with prostheses. Traditional surgical principles dictate removal of the prosthesis to control infection. Although successful salvage of prostheses in the presence of periprosthetic infections has been reported in the plastic and other surgical literature, salvage procedures remain seldom practiced. Reports in the plastic surgery literature have been limited to implant salvage following cosmetic breast augmentation and subcutaneous mastectomy with implants. Salvage of saline-filled expander prostheses used in breast reconstruction following mastectomy for cancer has not been previously reported. The authors review their experience with implant salvage in patients with periprosthetic infections following breast reconstruction for a 6-year period. Fourteen patients (13 with saline-filled expander prostheses and one with silicone prosthesis) underwent implant salvage. Salvage of the breast reconstruction was successful in nine patients. Staphylococcus aureus infection was associated with poorer salvage rate (p = 0.023). Previous radiotherapy to the chest wall did not affect the salvage outcome (p = 0.50). In selected patients, immediate salvage of a breast reconstruction in the presence of prosthesis-related infection remains an alternative to implant removal followed by delayed reconstruction.

Adult↗
PubMed2003

Infectious complications following breast reconstruction with expanders and implants.

The incidence of infection following breast reconstruction with expanders and implants ranges from 1 to 24 percent. Numerous factors associated with infection have been described; however, a one-variable at time setting and multifactorial analysis have not been performed. The purpose of this study was to analyze a set of factors that may predispose women to infection of the expander or implant. Between 1997 and 2000, a total of 168 implant reconstructions were performed in 130 women at a single institution. The mean age for all women was 48.2 years (range, 25 to 77 years). The factors that were analyzed included axillary lymph node dissection, chemotherapy, radiation therapy, tumor stage, timing of implant insertion, number of sides (unilateral versus bilateral), tobacco use, and presence or absence of diabetes mellitus. Statistical analysis was performed with stepwise logistic regression. Mean time to follow-up for all patients was 29 months (range, 12 to 47 months). Infectious complications occurred in 10 women (7.7 percent) and in 10 expanders or implants (5.9 percent). Infected implants were removed an average of 116 days following insertion (range, 14 to 333 days). Cultured bacteria included Staphylococcus aureus and Serratia marcescens. A significant association (p < 0.04) was detected between implant infection and radiation therapy. The chance for implant infection was 4.88 times greater for implants that were exposed to radiation therapy compared with those that were not. In addition, there was suggestive (p < 0.09) evidence that the chance of implant infection following lymph node dissection was 6.29 times higher than when no lymph nodes were removed. No significant association between implant infection and age, diabetes, tobacco use, tumor stage, timing of implant insertion, or chemotherapy was found.

Adult↗
PubMed2004

Accelerating tissue expansion by application of topical papaverine cream.

The rate of tissue expansion can be accelerated by papaverine through a special delivery system, according to an early report. Because the delivery system was complex and inconvenient, another means of administrating papaverine was tested to observe the rate of tissue expansion. In this study, 24 miniature pigs were divided equally into three groups. Four 150-ml silicone expanders were implanted into each pig in groups A and C. Four modified rectangular silicone expanders were also implanted into each animal in group B. During the expansion process, 1 g of 2% hydrochloride papaverine cream was applied topically onto the surface of each pig's expanding skin in group A two times daily, and hydrochloride papaverine solution was injected into the outer shell of each modified expander in group B weekly. Group C acted as the control group. The mean sum of the first four times of saline water volume that was injected into the expanders was 142.42 +/- 5.6 ml in group A, 128.72+/-4.8 ml in group B, and 106.38+/-3.28 in group C. There were statistical differences among the three groups. The mean sum of volume saline water that was injected into hind expanders was 137.51 +/- 5.1 ml in group A, 120.35 +/- 3.6 ml in group B, and 102.63 +/- 4.76 ml in group C, and there was a statistical difference among the three groups as well. There was no statistically significant difference in the thickness of fibrous capsules among the three groups. This study shows that the rate of tissue expansion can be accelerated by topical application of papaverine cream, and the rate is better than the rate of tissue expansion induced by the special drug delivery system.

Administration, Topical↗