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Soft-tissue expansion before total knee arthroplasty in arthrodesed joints. A report of two cases.

We report two cases in which arthrodesed knees were revised to total arthroplasties after the use of soft-tissue expanders. Case 1 had had multiple operations on her knee and had been arthrodesed for septic arthritis two years earlier. Case 2 had had knee arthrodesis for severe osteoarthritis 18 years before revision. In both patients, tissue expanders were used to increase the soft tissues available for cover and to help to mobilise the extensor mechanism. The operations were made much easier, and in both patients a range of motion from 0 degrees to 90 degrees was achieved at operation.

Adult↗

Pain and forehead expansion.

Tissue expansion of the forehead by intermittent bolus injection in three patients was noted to be extremely painful. This stimulated a prospective study in four patients whose discomfort was found to be related to a sharp rise in intraluminal pressure after bolus inflation. Tolerable infusion volumes were small (mean 6.25 cc) and associated with high pain scores (mean 7/10). Adequate expansion was protracted (mean 45 1/2 days) and was limited by pain. To eliminate the sharp rises in pressure associated with expansion by bolus injection, a syringe pump was used in two further inpatients. Adequate expansion was both quicker (mean 8.5 days) and less painful (mean pain score 2.6/10).

Aged↗

[Air tissue expansion, as an alternative to physiologic serum expansion: report of 30 cases].

There has been a renewed interest in cutaneous expansion as a plastic surgery procedure. Complications and failures remain considerable despite a more adequate and standardized technique. Based on a study of 30 cases of cutaneous expansion for burns sequelae, the authors emphasize the value of using air instead of physiological saline as filling medium, to reduce the negative repercussions on quality and quantity of cutaneous gain, related to the increasing weight of the prosthesis, even for large and possibly repeated expansion volumes.

Adolescent↗

Postmastectomy brachial plexus injury exacerbated by tissue expansion.

A neurapraxic injury to the brachial plexus was seen after modified radical mastectomy and immediate tissue expander placement. Neurological recovery proceeded until a sudden deterioration 42 hours after the fourth expansion. Deflation of the expander from an initial pressure of 18 mm Hg to 8 mm Hg led to relief from all acute symptoms, which were primarily in the distribution of the nerve most severely involved at the time of the initial injury, the median nerve. The history of previous neurapraxia and anatomical relationships between the tissue expander, pectoralis minor tendon, and neurovascular structures suggest that impairment of nerve function occurred through a compressive mechanism resembling a double-crush phenomenon.

Adult↗

Soft tissue expansion in the treatment of scar alopecia in preschool children.

Indigenous rubber silicon gel soft tissue expanders were used to treat 5 preschool children with scar alopecia. The scar resection rate wa 100%; no severe complication happened. The average healing time was 25 days after the improvement of technical method. This method is simple, effective and the expansion duration is short.

Alopecia↗