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At least 415 records · Page 23Linked to original sources
PubMed1992

[The surgical treatment of cicatrix alopecia of the hairy scalp using tissue expansion].

Surgical correction was carried out in 25 patients with cosmetically disturbing cicatricial scalp defects, due to injury, irradiation or infection. The use of tissue expanders, creating an increase in hair covered skin, has proved invaluable, giving excellent cosmetic result. In most patients complete closure of their defect was obtained with two operations: first placement of the expander and later its removal, excision of the scar and advancement of the flaps. In some patients additional punch grafts were applied. Complications occurred in two patients (leakage of the expander owing to an exostosis on the skull; infection via a filling tube placed percutaneously contrary to the protocol). If the protocol is meticulously followed, surgical treatment of cicatricial alopecia can be performed with minimal complications. On follow up the results were excellent and all patients were highly satisfied. It may be expected that the long-term result will remain excellent.

Adolescent↗
PubMed1994

Improving the latissimus dorsi myocutaneous flap with tissue expansion.

Although the latissimus dorsi myocutaneous flap is a safe and reliable technique for breast reconstruction, its versatility is limited when large cutaneous units are needed to resurface a heavily irradiated or scarred breast and chest wall. The thick back skin, in particular, may be unsuitable for reconstruction opposite either a hyperplastic or moderate sized but ptotic breast. Also, the likely need for a prosthesis can result in encapsulation and firmness. Expanding the latissimus flap has been suggested as a means of improving its aesthetic and reconstructive results. Indications for choosing an expanded flap in 10 patients included: (1) a need for autogenous tissue reconstruction of irradiated breast and chest wall tissues; (2) cutaneous coverage requirements that exceeded the availability of donor site skin; (3) the presence of a hyperplastic or ptotic contralateral breast that the patient preferred to match rather than alter; and (4) unavailability of an alternative flap such as a TRAM and unsuitability of an implant or expander without a flap. Results of this study in 10 patients requiring breast and chest wall reconstruction demonstrate that flap dimensions increased by approximately a factor of 1.5 after expansion. The latissimus flap was pre-expanded on the back before transfer in two patients when skin and soft tissues were inadequate, or was expanded post-transfer in eight patients for both immediate and delayed breast reconstruction. Eight patients underwent a total of two operations, including two who had nipple areolar reconstruction. Earlier in the series, two other patients had nipple areolar reconstruction performed as a third procedure. Mean follow-up was 15.1 months. Complications consisted of partial dehiscence of the donor site wound in one patient after transfer of an expanded flap measuring 16 x 28 cm; three patients developed symptomatic seromas requiring drainage. All patients had soft, nonpalpable implants and no distortion of the flap's shape. The application of tissue expansion techniques yields latissimus flaps that are notable for their capacious dimensions, thinned tissues, and improved pliability. Advantages include an avoidance of reduction or mastopexy procedures in patients with large, ptotic breasts and uncomplicated wound healing in those with a history of prior irradiation. Not all latissimus flaps need to be expanded, but some can be significantly improved when specific indications are present. Most importantly, expanded latissimus flaps appear to resist the early formation of periprosthetic encapsulation.

Adult↗
PubMed1994

[Staged tissue expansion in the surgery of suppurative wounds].

To close extensive infected wounds and to replace long bone defects, along with other methods a method of graded tissue strain (GTS) has been developed and introduced into practice (246 patients). The method differs from all others in that it requires no transfer of elaborate flaps while replacing soft tissue defects; and no graft or foreign body is introduced externally into the wound in replacing long bone defect. Soft tissue defect is gradually replaced by wound-adjacent intrinsic tissues, the wound is closed by related skin and bone defect is filled by an osseous regenerate which is formed during graded transposition of the osteotomized fragment. At the same time good blood supply and tissue innervation retain, which contributes to their resistance to purulent infection. The analysis of the findings has led to the conclusion that GTS is an indispensible contribution to the development of plastic purulent surgery allowing the anatomic and functional integrity of the diseased segment to be restored.

Humans↗
PubMed1991

Tissue expansion in the head and neck. A 6-year review.

More than 100 patients (38 in the head and neck) have been treated by the insertion of tissue expanders since the technique was introduced six years ago. Our methods have been refined as we have learned more, and these improvements are described. Morbidity is high when untrained surgeons start to use the technique. The most important decision is the planning of the expander and filling port pockets, but above all the location of the incision(s): Incisions must be kept small and away from the defect, the pocket, and the future flap. Intraoperative filling of the expander reduces the need for drains by preventing haematoma and seroma formation, and reduces the formation of expander envelope folds. The optimal location of the valve is a "quiet" area above or lateral to (or both) the expander, and at least 7 cm away. Mathematical formulas are useless in predicting available flap length, as elasticity and contractility depend on individual factors. A good estimation of flap length is twice the height of the expander above the skin surface or the distance over the dome of the expander minus the corresponding measurement of its base. Overexpansion by 30-50% makes the procedure more predictable.

Adolescent↗
PubMed1997

Computer-aided preoperative planning of tissue expansion.

The aim of this paper is to introduce a computer program developed to provide objective, quantitative data useful to ensure proper expander selection when having to use a rectangular tissue expander. The program is developed to calculate the volume of a rectangular tissue expander to obtain the exact amount of yield needed to allow for reconstruction of a determined defect. The only data to be supplied are the length and the width of the defect to be reconstructed. In our opinion, although its use is not aimed at replacing clinical judgment based on experience and careful observation, this program may be considered a simple and useful adjunct for the inexperienced surgeon (or the occasional operator) planning to use a rectangular tissue expander.

Decision Support Techniques↗