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At least 397 records · Page 22Linked to original sources
PubMed1993

Experimental effects of intraorbital tissue expansion on orbitomaxillary growth in anophthalmos.

A skeletal growth study evaluating an intraorbital tissue expander as a globe replacement in anophthalmos was conducted in an infant animal model. Twenty-one 21-day-old kittens were equally divided into the following three groups: a control, a unilaterally enucleated, and an enucleated-expanded group. Postoperative three-dimensional computed tomographic scans were obtained at 5 months of age immediately before study termination. Linear orbital, orbitomaxillary, and zygomaticomaxillary dimensions were measured on the scans and compared at necropsy with orbital volume assessment on the dry skulls. Control animal orbits averaged 21.5 mm in height, 21.0 mm in width, and 5.1 cm3 in orbital volume, and an orbitomaxillary-zygomaticomaxillary height-to-width ratio of 31.0: 24.5. The control side, its contralateral side, and the contralateral orbits of the treated sides were not significantly different. By study completion, enucleation resulted in a significant loss of orbital volume (mean, 1.9 cm3; p < 0.001) confirmed by deficient orbitozygomaticomaxillary measurements. The expanded orbits showed no loss of volume (mean, 5.2 cm3; p > 0.1) and normalization of all linear midfacial structures. This study demonstrates that early expansion emanating from within the orbital soft tissue positively affects both the skeletal and lid anomalies associated with congenital globe loss or early enucleation.

Animals↗
PubMed2002

Easy tissue expansion of prelaminated mucosa-lined flaps for cheek reconstruction in a canine model.

In head and neck reconstruction, there is sometimes the need for a skin flap lined with mucosa. The object of this study was to determine whether small pieces of mucosa grafted onto the undersurface of a skin flap can be expanded in a reasonable time to provide the material required to reconstruct a full-thickness cheek defect as a free flap. The study consisted of two phases: prelamination and expansion of the flap, and vascularized free-tissue transfer of the flap. Six adult mongrel dogs were used. First, a 5 x 10-cm flap based on the saphenous vessels was elevated on the lower leg, and then four 1 x 2-cm pieces of mucosa harvested from the tongue were grafted onto the undersurface of the flap. A tissue expander (5 x 10 cm) was then placed under the flap, and the incision was closed primarily. The expanders were initially filled with just enough normal saline to obliterate dead space immediately after surgery. The expansion was continued twice weekly for 3 weeks until sufficient expansion was obtained. Two of six flaps were followed for an additional 6 weeks after the 3-week expansion period to observe whether additional mucosa could be obtained. After measurement of the mucosal area, each flap was transferred as free flap to reconstruct an iatrogenic cheek defect. The increase of mucosal surface area was compared with the original graft, and differences were analyzed using the paired t test. All flaps were successfully expanded without any complications. Histologic evaluation revealed that grafted mucosa took well without evidence of graft necrosis, and the intergraft area was covered with histiocytes. Angiography revealed well-defined vascular structures covering the entire area of the flap. The new mucosal area (23.5 +/- 2.4 cm2) was significantly larger than the original mucosal graft (8.7 +/- 0.9 cm2) (p < 0.001). The net increase of the mucosal area was 172.9 +/- 32.4 percent. The increase of mucosal area in two flaps, following a 6-week consolidation period after 3 weeks of expansion, was only slightly greater (25.9 +/- 1.3 cm2) than those without the consolidation period (22.3 +/- 1.8 cm2). This increase of the mucosal area appears to be related to the amount of expansion, and not to the length of the consolidation period. The flaps were successfully transferred as free flaps to reconstruct the full-thickness cheek defects without major complications. Although a staged operation to allow flaps to mature is needed, the present procedure has the advantages of providing a mucosa-lined flap and allowing primary closure of the donor site. The authors conclude that expansion of this flap has great potential in reconstructive surgery.

Animals↗
PubMed1992

Tissue expansion in the extremities using external reservoirs.

Over a 24-month period, 18 patients had 33 expanders placed in the extremities. Twelve expansions were performed in the upper extremity, and 21 in the lower extremity. Indications for expansion include scarring, excision of skin grafts, tumor excision, burn scars, tattoos, or unacceptable incisional scars for revision. Of the 12 expansions performed in the upper extremity in seven patients, nine were successful. Nine expansions in the thigh and two expansions in the region of the knee were completed without complication. Three expansions were performed in the distal lower extremity following crush injury to remove scarring, and all three failed. Seven expansions were performed in the foot for removal of scarred tissue. There was one infection, two skin necroses on the dorsum of the foot, and one implant exposure. Seven complications in the lower extremity occurred in these areas with an infection rate of 20%. The remaining 23 expansions were performed for soft tissue defects in the upper extremity or in the lower extremity above the level of the mid-calf, with only two complications of implant exposure or infection. Therefore, the infection rate and complication rate in the upper extremity and above the knee was only 6%. Overall, 23 of the 33 expansions, or 70%, were taken to completion with a successful advancement of expanded flaps. Overall, complications occurred in 30% of patients, all eventually requiring removal of the expander.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Long-term nasal mucosal tissue expansion use in repair of large nasoseptal perforations.

Reperforation rates of large, surgically closed nasoseptal perforations remain unacceptably high (30% to 70%). With the advent of newer surgical techniques, including external decortication rhinoplasty and midface degloving, excellent exposure of the intranasal anatomy is afforded. The limiting factor of these approaches is the deficiency of local intranasal mucosal lining, which is used to close large septal perforations. The paucity of nasal mucosal lining results in excessive tension on the perforation closure suture line that leads to distal flap ischemia, anastomosis breakdown and, ultimately, reperforation of the septum. Alternatively, using intraoral mucosal flaps of sufficient length and width to close large perforations results in significant and unacceptable donor-site morbidity. We present our technique of harvesting additional local endonasal mucosa using long-term soft-tissue expanders. Long-term nasal mucosal expansion was used in the closure of large septal perforations in five patients. Complications included one case of expander exposure and the morbidity of prefacial expander injections. Total closure of all five septal perforations was documented at the 1-year postsurgical visit. Histologic and electron-microscopic examinations of the expanded nasal floor mucosa are presented.

Collagen↗