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At least 415 records · Page 23Linked to original sources
PubMed2005

The suspension technique to avoid the use of tissue expanders in breast reconstruction.

BACKGROUND: Immediate or delayed breast reconstruction is usually performed using expansion techniques or pedicled or free flaps. The suspension technique hereby described can reduce the number of surgical stages, as well as donor-site sequelae. TECHNIQUE: The authors describe a new technique of breast reconstruction with implants using a nonabsorbable mesh to create a superior abdominal cutaneous flap, which contributes to the skin envelope of the reconstructed breast. The advantage of this technique is the opportunity to use immediately a definitive prosthesis also in cases requiring a mastectomy with the resection of a large amount of skin, consequently reducing the indications of tissue expanders or myocutaneous flaps. RESULTS: We performed the "suspension technique" in 67 cases of immediate reconstruction and in 6 cases of delayed reconstruction. No further surgery under general anesthesia was necessary in 56 patients (76.7%). In 14 cases (19.2%), a second operation under general anesthesia was necessary for implant replacement, capsula revision, and nipple and areola (NAC) reconstruction. In 3 cases (4.1%), implant removal was necessary due to implant exposition or infection. In 33 patients, only NAC reconstruction was performed under local anesthesia. In our series, capsula contracture was graded as Baker I in 24 cases, grade II in 16 cases, grade III in 9 cases, and grade IV in 1 case. Breast symmetry, patient's satisfaction, and surgeon cosmetic evaluation were respectively scored 7.56, 7.75, and 7.60 (range from 1 to 10). CONCLUSION: In conclusion, this technique can be applied in cases requiring a large skin resection at the time of mastectomy and refusing a reconstruction with myocutaneous flaps or a second surgery, necessary if a reconstruction with tissue expanders is planned.

Adult↗
PubMed2005

The conjoined sternalis-pectoralis muscle flap in immediate tissue expander reconstruction after mastectomy.

The sternalis muscle is an accessory muscle of the anterior chest wall. This is a rare anatomic variant reported in approximately 8% of the population, with variation among races. While several anatomic studies of the sternalis muscle exist, nothing in the literature addresses the implications of this muscle on reconstruction of the breast after mastectomy. Based on several encounters of this muscle variant by the senior author over a 15-year period, we offer a strategy and rationale for dealing with this rare, but known, anatomic variant during immediate tissue expander reconstruction of the breast after mastectomy. First is the importance of recognizing the presence of a sternalis muscle, which may present in a variety of configurations. We offer our technique of conjoined sternalis-pectoralis muscle flap during tissue expander reconstruction of the breast. This allows for the creation of a larger, more properly placed submuscular pocket with adequate muscle coverage of the tissue expander. Our experience illustrates that the reconstructive surgeon must be familiar with the sternalis muscle and be prepared to adapt his or her technique for tissue expander placement when faced with this accessory muscle.

Adult↗
PubMed2006

Calvarial bone healing under spring distension at continuous forces.

The aim of the present study was to evaluate in young animals the dynamics of calvarial bone healing when exposing a bone defect to continuous forces for up to 13 weeks. Six-week-old rabbits after a sagittal suture strip craniectomy were randomized for either of the following protocols: (1) no spring was applied (n = 7); (2) a titanium-molybdenum alloy (TMA) lower-force spring was inserted across the craniectomy gap (n = 9); (3) a stainless steel (SS) higher-force spring was applied (n = 8), or (4) sham operation (n = 8). Results showed that the surgically created calvarial bone gap was after 3 weeks kept widened both when a spring of lower force (TMA) and when a spring exerting a higher force (SS) was applied. At 6 weeks, none of the rabbits of the spring-exposed (2 and 3) groups had any bone bridging the gap, while bone bridging was visible in animals of the 2 groups (1 and 4) lacking springs. Strikingly enough, in both spring-treated groups, the surgically created defect was still after 13 weeks incompletely bridged by bone, interposed by connective tissue, most evidently in those exposed to higher forces (SS). In contrast, a normal sagittal suture enclosed by lamellar bone was seen in both the sham and the strip groups. We conclude that exposing a surgically created calvarial bone defect to continuous mechanical forces delayed the bridging of the bone defect by at least 13 weeks, even if the force exerted by either spring was very low. In any case, when a higher force (SS group) was applied, the bone reunion was efficiently prevented. No side effects were recognized.

Animals↗
PubMed2005

Reconstruction of major forehead soft tissue defects with adjacent tissue and minimal scar formation.

Repair and reconstruction of soft tissue defects involving over 50% of the forehead using remaining forehead tissue has not been reported in the literature. The few existing reports mainly concern cases in which less than half of the forehead was involved. The forehead comprises one third of the face and with regard to its prominent position, it is one of the major contributing components to facial beauty. Considering the excellent color, thickness, and quality matching of the adjacent forehead skin, it is considered the ideal substitute for repair of forehead defects. Use of skin graft or free flaps for reconstruction of defects involving 50% or more of the forehead have not reported acceptable results because of the lack of similarity of the donor tissue with the remaining forehead tissue. In this study, we describe successful reconstruction of major forehead soft tissue defects of two thirds to three fourths of the forehead with use of a tissue expander and transverse supratrochlear pedicle flap in four patients who were diagnosed with giant hairy nevus. There were no serious complications such as hematoma, bleeding, infection, or flap necrosis. We recommend this technique for reconstruction of extensive forehead soft tissue defects.

Adolescent↗
PubMed2004

Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction.

INTRODUCTION: We hypothesized botulinum toxin (BT) infiltration of the chest wall musculature after mastectomy would create a prolonged inhibition of muscle spasm and postoperative pain, facilitating tissue expander reconstruction. METHODS: An Institutional Review Board (IRB)-approved prospective study was conducted of all patients undergoing mastectomy with tissue expander placement during a 2-year period. Study patients versus controls had 100 units of diluted BT injected into the pectoralis major, serratus anterior, and rectus abdominis insertion. Pain was scored using a visual analog scale of 0 to 10. Wilcoxon rank sum test was used for continuous variables and the chi2 test for nominal level data to test for significance. RESULTS: Forty-eight patients were entered into the study; 22 (46%) with and 26 (54%) without BT infiltration. Groups were comparable in terms of age (55 +/- 11 years versus 52 +/- 10 years; P = 0.46), bilateral procedure (59% versus 61%; P = 0.86), tumor size (2 +/- 2 cm versus 2 +/- 3 cm; P = 0.4), expander size and volume (429 +/- 119 mL versus 510 +/- 138 mL; P = 0.5). The BT group did significantly better with pain postoperatively (score of 3 +/- 1 versus 7 +/- 2; P < 0.0001), during initial (score of 2 +/- 2 versus 6 +/- 3; P = 1.6 x 10(-6)), and final expansion (1 +/- 1 versus 3 +/- 2; P = 0.009). Volume of expansion per session was greater thus expansion sessions required less in the BT group (5 +/- 1 versus 7 +/- 3; P = 0.025). There was a significant increase in narcotic use in control patients in the first 24 hours (17 +/- 10 mg versus 3 +/- 3 mg; P < 0.0001), initial as well as final expansion periods (P = 0.0123 and 0.0367, respectively). One expander in the BT group versus 5 in the control group required removal (P = 0.13). There were no BT-related complications. CONCLUSION: Muscular infiltration of botulinum toxin for mastectomy and tissue expander placement significantly reduced postoperative pain and discomfort without complications.

Analgesics, Opioid↗
PubMedDate not supplied

Soft-tissue expander failure in severe equinovarus foot deformity.

Soft-tissue expanders have recently been reported to be useful in clubfoot surgery. We report our experience with this procedure in five patients with seven severe equinovarus foot deformities. The primary diagnoses of these patients included distal arthrogryposis, cerebro-oculo-facial syndrome, ischemic contracture and spina bifida. Our patients' major complications included ischemia, infection, and sepsis, which resulted in premature removal of the soft-tissue expanders in five of seven clubfeet. Minor complications, such as partial wound dehiscence, occurred in the two successful expansions. Predisposing factors may include soft-tissue expanders with self-contained ports, poor compliance, and extremely tight tissues that limit the subcutaneous space available for expansion, with resultant diminution of the vascular supply to the overlying skin.

Arthrogryposis↗
PubMed1996

Tissue expander causing iatrogenic difficult intubation.

Difficulty during tracheal intubation may occur due to a number of anatomical factors and pathological conditions. These factors may be influenced by earlier surgical manoeuvres, so that difficulty may occasionally be encountered at subsequent operation. One such case of 'iatrogenic' difficulty, where a tissue expander beneath the anterolateral skin of the neck caused transient intubation problems, is reported.

Adolescent↗
PubMedDate not supplied

Improving hepatic and portal venous flows using tissue expander and Foley catheter in liver transplantation.

BACKGROUND AND OBJECTIVE: Vascular reconstruction is important in liver transplantation because its obstruction causes graft failure and eventual loss. Vascular outflow obstruction may be due to graft malposition. We describe our experience with liver allograft repositioning using tissue expander and Foley catheter to improve hepatic and portal venous outflows. PATIENTS AND METHODS: A total of seven patients who received liver transplantation at our institution developed hepatic and/or portal venous obstruction during final graft positioning detected by Doppler ultrasonography (hepatic vein flow <10 cm/s; portal vein flow <12 cm/s). Chart and operative records of these patients were reviewed. Technique of operation, donor-recipient characteristics, use of tissue expander or Foley catheter to improve venous outflow, complications, and outcome were analyzed. RESULTS: Hepatic and/or portal venous obstruction were detected after portal reperfusion. We used commercially available tissue expander used in plastic surgery and Foley catheter to reposition the graft. Tissue expanders were used in three recipients (age: 27-46 yr). Foley catheters were used in four recipients (age: 7 months-53 yr). One recipient used both tissue expander and Foley catheter. Expanders were filled with 300-770 mL saline and placed into the right subphrenic space. Foley catheters were filled with 15-75 mL saline. Significant improvements in hepatic and/or portal venous outflow were detected by Doppler ultrasonography post-graft repositioning. Aspiration of expander and Foley catheter contents was started from 6th to 27th postoperative day under sonographic guidance. All expanders and catheters were removed by the 19th-56th postoperative day (mean: 38 d). Complications included chylous ascites (1/7), bile leak (1/7), tube drain infection (2/7), septicemia (2/7). All complications were successfully managed by non-operative interventions. There was no outflow obstruction detected by ultrasonography before and after removal of expanders and catheters. One- and two-year graft and patient survivals were both 100%. CONCLUSION: The use of tissue expanders and Foley catheters to improve hepatic and portal venous outflow in malposed liver allografts is a simple and safe method after liver transplantation.

Adolescent↗
PubMed1992

Tissue expansion in pig skin--a histochemical approach.

In the present study, a porcine model for controlled skin expansion was investigated to improve our understanding of epidermal and vascular responses following stretching. The model is of outstanding importance not only for the clinical use of tissue expansion but provides interesting data for skin physiology and oncology, too. Thirteen out of 15 animals, who underwent silicone tissue expander implantation showed good clinical results. In all of them, skin biopsies were taken at the end of a controlled tissue expansion procedure (final expander volumes 350 or 500 ccm): one tissue specimen was obtained from the centre of the expanded skin area and a second from the neighbouring but nonexpanded skin. The tissue specimens were immediately frozen in liquid nitrogen and processed to 4 microns thick acetone-fixed frozen sections. Lectin histochemistry and immunohistology were performed using the following techniques: direct and indirect immunofluorescence technique (DIFT, IIFT), immunoperoxidase technique (POX) with either 3,3'-diamino-benzidine (DAB) or 3-amino-9-ethyl-carbazole (AEC). The histochemical findings were supplemented by measurements of the number of vital epidermal cell layers, the epidermal thickness (microns), and the papillary vascular count per visual field. There was a significant diminuation of the vascular count (mean +/- S.D. = 55.0% +/- 12.5%; U-test: p less than 5%). By immunohistochemistry, a loss of the basal cell reactivity for the following antibodies was noted: ACAM (against calmodulin), K 8.12 (against keratins 13 +/- 16) and A51-B/H4 (against keratins 8, 14, 18). There was a remarkable increase of filaggrin expression in the uppermost spinal cell layers in expanded skin, which was most pronounced in those specimens with the shortest interval to the last fluid injection into the expander. We gained no evidence for alterations of the expression of suprabasal epidermal keratins, lectin binding sites (UEA I, PNA, ConA, WGA), and vascular lectin- and immunoreactivity due to tissue expansion. The subdermal capsule, which had formed around the silicone expander, was strongly vimentin-reactive. In conclusion, controlled tissue expansion is capable to change the basal cell phenotype--a feature which is shared with a number of conditions with increased proliferative activity and with the epidermis covering different skin tumours. The regular expression of suprabasal keratins and epidermal lectin binding sites provides evidence for a normal epidermal cell differentiation. Furthermore, the porcine skin is a reliable model for studying physiology and pathophysiology of human skin.

Animals↗
PubMed1995

Breast reconstruction using permanent tissue expanders.

The breast is a variable organ and as such reconstructive surgeons need to use a variety of reconstructive techniques. Prosthetic reconstruction is a good technique for women who are either unsuitable for or not accepting of autogenous tissue reconstruction. We reviewed the last five years' experience at Monash Medical Centre with permanent tissue expander breast reconstruction. Forty patients underwent reconstruction of 54 breasts. Immediate reconstruction was performed in 70% with an overall average patient age of 45 years. The selection criteria, advantages, and disadvantages of this technique are discussed. Inflation of expanders took an average of 71 days and creation of breast mound (excluding nipple/areolar reconstruction) took an average of 2.3 operations. Overall aesthetic results have been judged to be good to excellent in 81%. Symmetry was more easily achieved in bilateral reconstructions. Capsular contracture rate was Baker Grade I or II in 83%. Minor complications occurred in 17% of patients. We believe that there still exists a significant number of women who are either unsuitable for or not accepting of autogenous tissue reconstruction. It is this group of women who, if well selected, can be reconstructed safely and efficiently by the use of permanent tissue expander breast prosthesis.

Adult↗