PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Tissue Expansion”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 577 records · Page 32Linked to original sources

Tissue dosimetry expansion and cross-validation of rat and mouse physiologically based pharmacokinetic models for trichloroethylene.

Trichloroethylene (TCE), a volatile liquid used as a degreasing agent, is a common environmental pollutant. In 2001, the EPA published a draft risk assessment for TCE that incorporates dosimetry predictions of physiologically based pharmacokinetic (PBPK) models. The current modeling effort represents an expansion and extensive tissue dosimetry validation of rodent PBPK models for TCE. The pharmacokinetics of TCE in male Sprague-Dawley (S-D) rats were characterized (1) during and after inhalation exposure to 50 or 500 ppm TCE, (2) following administration of 8 mg/kg TCE PO, and (3) following intra-arterial injection of 8 mg/kg TCE. Blood and tissues (including liver, kidney, fat, skeletal muscle, heart, spleen, gastrointestinal tract, and brain) were collected at selected time-points from 5 min up to 24 h post initial exposure. The fat compartment was modified to be diffusion-limited to predict the observed slow release of TCE from the fat. The addition of a deep liver compartment was necessary to accurately predict the slower hepatic clearance of TCE for all three exposure routes. Simulations of liver concentrations following gavage of male B6C3F1 mice with 300-2000 mg/kg TCE were also improved with the addition of a deep liver compartment. Liver predictions were calibrated and validated using a cross-validation technique novel to PBPK modeling. Splitting of compartments did not significantly affect predictions of TCE concentrations in the liver, fat, or venous blood. This model expansion and validation increases both the utility and our confidence in the current use of rodent TCE PBPK models in human health risk assessment.

Adipose Tissue↗

Primary skin closure in large myelomeningoceles.

Numerous reconstructive methods have been described for the soft tissue closure of large myelomeningoceles. Recent advances in techniques of soft tissue expansion provide yet another reconstructive option. Tissue expansion allows for primary closure of the defect with surrounding tissue, resulting in minimal donor site morbidity. This report illustrates the technique of tissue expansion in the closure of a large myelomeningocele.

Humans↗

Graves' ophthalmopathy: eye muscle involvement in patients with diplopia.

BACKGROUND: Diplopia identifies patients with eye muscle involvement in Graves' ophthalmopathy (GO). OBJECTIVE: To identify clinical parameters that could eliminate the need for magnetic resonance imaging (MRI) to assess the activity of inflammation in the eye muscles of GO patients with diplopia. METHODS: In 43 patients with GO with recently developed diplopia, orbital ultrasound and MRI were performed. Muscle diameters and MRI T2 relaxation times were measured, and the amount of orbital connective tissue was calculated from MRI scans and compared with ultrasound readings, diplopia grades, degree of protrusion, ocular pressure, tear production, antibody levels and hormonal parameters of thyroid function. RESULTS: No correlation was found between diameters of 233 extraocular muscles measured by MRI and by ultrasound. For each of the four muscles, there was a diameter above which ultrasound was always unreliable. MRI data were used in further analysis. Of the muscles examined, the inferior rectuses were the most frequently enlarged - at least one, in 93% of cases. Medial, lateral and superior rectuses were enlarged in 59%, 37% and 34% of the orbits respectively. The pattern of muscle involvement of the two orbits tended to be symmetric (r=0.49, P=0.003), particularly for the medial rectuses (r=0.90, P=0.000). Proptosis correlated with the sum of the muscle diameters for a given eye (right eye: r=0.54, P=0.003; left eye: r=0.57, P=0.001), but it failed to correlate with the amount of orbital connective tissue. In 53% of the patients, normal T2 relaxation times were found in all eight muscles. There was only a weak correlation between muscle thickness and T2 relaxation time (r=0.49, P=0.003), indicating that muscle enlargement alone is not a sign of disease activity. The severity of diplopia was independent of T2 relaxation time. The amount of orbital connective tissue showed a negative correlation with the greatest T2 relaxation time for a given eye (r= -0.52, P=0.004); this suggests that disease types exist that have predominant muscle involvement and predominant connective tissue expansion. No correlation between connective tissue expansion and proptosis, diplopia grade, muscle thickness or disease duration was found - that is, connective tissue expansion is not a major factor in diplopia. Both muscle and connective tissue findings were independent of thyroid function. CONCLUSION: Ultrasound and MRI eye muscle diameter readings do not correlate, because of the inherent inaccuracy of orbital ultrasound. Muscle enlargement alone does not mean oedematous swelling and active disease. Neither ultrasound, nor any combination of 11 clinical and laboratory parameters provided the degree of information on muscles and connective tissue that was obtainable by MRI. In unclear cases of recently developed diplopia, before orbital decompression surgery, in the case of treatment failure or if, for any other reason, imaging is needed in GO, MRI is the method of choice.

Adult↗

The fabrication and use of an extraoral surgical guide for implant placement coincident with soft tissue matrix expansion grafts: a clinical report.

During soft tissue matrix expansion (tent pole) graft (STMEG) surgery, the traditional intraoral surgical guide for dental implant placement cannot be used because the surgery is initiated and maintained outside the oral cavity. The essential records established from an intraoral surgical guide must be transferred to an extraoral surgical guide. This clinical report describes the fabrication and use of an extraoral surgical guide employed during STMEG surgery.

Acrylic Resins↗

Tissue expander complications in plastic surgery: a 10-year experience.

INTRODUCTION: Tissue expanders have been of great value in plastic surgery. Tissue expansion was developed for a specific indication; however, within a very short time, the concept of tissue expansion found wide applicability. From 1990 to 1999, 315 expanders in 164 patients were utilized. A retrospective analysis of complications and prognostic factors for complications were done. METHODS: The indications for tissue expansion were burns (50%), trauma (32%), and sequelae of previous surgery (8.8%). The expanders were inserted most frequently in the scalp, trunk and neck. RESULTS: There were 22.2% of complications and the most common were expander exposure (50%), infection (24%) and bad function of the expander (12.8%). The present study revealed an increased rate of minor complications in the group of 0 to 10 years of age and an increased rate of major complications for face and neck expansions compared to trunk expansion. There were no increased complication rates for the other age and anatomic site groups, previous expansion, concomitant expansion and type of expander used. CONCLUSIONS: The outcomes from tissue expansion procedures done in our hospital are similar to those reported in the literature. Tissue expansion is a good and safe technique.

Adolescent↗

Chest wall reconstruction.

Chest wall defects are frequently encountered in all regions of the chest. Initial defect assessment includes evaluation of location, extent, and etiology of the defect. Reconstructive options include flap transposition, tissue expansion, and microvascular composite tissue transplantation. Partial thickness defects are readily covered with skin grafts if viable muscle is present in the wound base. Complex defects, particularly related to wound débridement for osteomyelitis or osteoradionecrosis, are covered with regional muscle or musculocutaneous flaps. Extensive full-thickness defects frequently require restoration of the bony defect. Split rib grafts are preferred for elective sterile extirpative defects. Complex defects with unfavorable wound environment (chronic open wound or osteoradionecrosis) may require use of Prolene mesh to maintain chest wall stability and to provide support for the overlying flap. Tissue expansion is useful for partial thickness defects in order to provide optimal contour and skin quality at the site of reconstruction and to avoid additional scars at distant donor sites (see Fig. 6). Microsurgical composite tissue transplantation will allow complex defect closure when regional muscle or musculocutaneous flaps are unavailable. With careful defect analysis in regard to reconstructive requirements, the surgeon may select appropriate options from the reconstructive triangle to accomplish safe chest wall reconstruction with optimal form and function.

Humans↗

Complex facial nevi: a surgical algorithm.

Sixty-six children with large congenital nevi of the face were surgically managed in our center during the last 8 years. All patients with a lesion that posed a reconstructive challenge were included in the study. None could be effectively dealt with by excision and simple primary closure. To simplify description and evaluation, the patients were divided into three groups. Group I had 15 patients with relatively small lesions (1- to 3-cm maximal diameter) that were confined to one aesthetic unit of the face and could be reconstructed in one stage. Reconstruction was usually achieved by using local skin flaps or with full-thickness skin grafting. Group II had 28 patients with medium-sized lesions (3- to 12-cm maximal diameter) that involved one or two aesthetic units and required not more than two stages for reconstruction. These patients usually needed either serial excisions and/or skin grafting or a two-stage tissue expansion procedure (insertion of tissue expanders and reconstruction). Group III had 23 patients with very large lesions (over 12 cm in maximal diameter), some covering half of the face and thus involving several aesthetic units and requiring multiple stages for reconstruction. These patients required a combination of tissue expansion procedures, large faciocervical and scalp/forehead skin flaps, full-thickness skin grafting, and serial excisions for reconstruction. The anatomic distribution of the lesions over the various aesthetic units is described, as are the reconstructive techniques with advantages and disadvantages of each, reflecting on outcome. The approach to the larger complex lesions is detailed. Based on our experience, a reconstructive algorithm is proposed.

Adolescent↗

Scalp expansion in the treatment of male pattern baldness.

Tissue expansion has been extremely valuable in the treatment of traumatic scalp defects. We have recently used expansion techniques in the treatment of male pattern baldness. Expansion has been used in conjunction with scalp-reduction procedures and pedicled hair-bearing flaps. Flaps have been designed as Juri flaps, and in one patient, a new posteriorly based flap was used. This design gives the advantage of a more natural-appearing hairline and forward-growing hair. The major advantage of tissue expansion in the treatment of male pattern baldness is that it generates new hair-bearing scalp. The increase in vascularity which occurs during expansion allows for large, safe, and predictable flaps. Donor sites are also relatively easily closed. The disadvantages of expansion include the need for two or more surgical procedures and multiple office visits. There is also some discomfort following expansion and a cosmetic defect as the expanders become larger. Complications include infection, exposure or extrusion, deflation, and hair loss. Tissue expansion combined with scalp reduction and pedicled hair-bearing flaps have proved to be a valuable technique in the treatment of male pattern baldness with a high degree of patient satisfaction.

Adult↗

Maximising the use of tissue expanded flaps.

Tissue expansion offers the advantages of supplying tissue similar in texture and colour to the defect to be covered. However, to maximise the result, the expanded tissue must be used in the most efficient way possible. Rectangular expanders have been shown to yield the most available tissue. A technique to maximise the use of expanded tissue with a rectangular tissue expander is described. The technique is one of an advancement flap that maximises the use of expanded tissue in both a vertical and horizontal direction by adding backcuts to the sides (and interposing triangles of local tissue into these backcuts) as well as the base of the flap. This technique has been successfully applied to 11 children (17 expanders) undergoing tissue expansion during a 19 month period.

Adolescent↗

Long-term results of total knee arthroplasty after the use of soft tissue expanders.

The success of total knee arthroplasty can be jeopardized by poor wound healing. In the current study, the results of knee arthroplasty after soft tissue expansion were reviewed retrospectively in 27 patients (29 knees) at risk for problematic healing. The incidence of wound complications was recorded for all patients after the expansion procedure and the arthroplasty. A Knee Society score also was calculated at the latest evaluation. Minor wound complications occurred after 21% (six of 29) of the tissue expansion procedures and after 18% (five of 28) of the subsequent arthroplasties. One major wound complication occurred during tissue expansion necessitating abandonment of the planned arthroplasty. No major wound complications occurred in those patients who underwent knee arthroplasty. At an average followup of 34.4 months, the average Knee Society score was 83.7 points. The results of the current study show that the technique of soft tissue expansion before total knee arthroplasty in patients at high risk for wound healing problems can successfully prevent catastrophic wound complications after the arthroplasty procedure and can avoid the need for disfiguring soft tissue reconstructions.

Adult↗

Calvarial deformity and remodeling following prolonged scalp expansion in a child.

A main concern in the use of scalp tissue expansion in the pediatric population has been the risk of skull deformation. Little is known about the long-term effects of tissue expansion on the skull and the ability of the skull to remodel following removal of the tissue expander. We report a recent case in which a 5-year-old boy had a fully inflated tissue expander retained under the scalp for a 15-month period. At surgery for removal of the implant the patient was noted to have a profound skull deformity characterized by severe calvarial depression and ridging. The patient underwent scalp reconstruction. Follow-up at 6 months revealed nearly complete remodeling of the skull with minimal visual deformity. This case demonstrates not only the profound bony deformity that can result from tissue expansion, but also the striking ability of the pediatric skull to remodel.

Bone Remodeling↗

Heterogeneity of DM kinase repeat expansion in different fetal tissues and further expansion during cell proliferation in vitro: evidence for a casual involvement of methyl-directed DNA mismatch repair in triplet repeat stability.

We have analysed the mitotic behaviour of expanded CTG repeats in somatic tissues and cultured somatic cells from myotonic dystrophy (DM) fetuses using indirect and direct methods. Heterogeneity of expansions between fetal tissues was demonstrated in a 16 week old fetus whereas there was no evidence for such a somatic heterogeneity in a 13 week old fetus. Dilution plating of cultured cells from an adult patient and a fetus resulted in isolation of clones showing single expanded restriction fragments when the donor showed a heterogeneous smear of expansions or a single expanded fragment. During proliferation in vitro to 45 doublings, DM cells experienced highly synchronous further repeat expansion which first became evident at approximately 15 cell generations and reached a plateau of maximum expansion at approximately 200 days. When mathematically expressed as a function of culture time the dynamics of expansion of restriction fragments followed a sigmoid curve. This unstable behaviour of CTG repeat expansions in DM was compared to the mitotically stable patterns of full mutation in fragile X fetal tissues and led to the hypothesis that methylation of CpGs within the repeat sequence is a stabilizing factor of largely expanded CGG and GCC repeats allowing for efficient methyl-directed strand-specific DNA mismatch repair.

Adult↗

Adjuncts to scalp reduction surgery. Intraoperative tissue expanders and hyaluronidase.

Scalp reduction has become an important part of the cosmetic surgeon's armamentarium in the treatment of male pattern alopecia. Recently, the use of two-stage tissue expansion has been advocated for scalp reduction. Intraoperative tissue expansion obviates many of the disadvantages of delayed expansion and increases the yield of excised scalp by 20-30% over standard reduction techniques in the 20 patients studied. The addition of hyaluronidase to the local anesthetic facilitates its diffusion, enhancing anesthesia and the ease of dissection. Therefore, the use of intraoperative tissue expansion and the addition of hyaluronidase to the local anesthetic are two separate adjuncts to scalp reduction surgery.

Alopecia↗

Increased survival and vascularity of random-pattern skin flaps elevated in controlled, expanded skin.

Controlled clinical tissue expansion, a new technique of providing donor tissue, results in an increase in surface area of expanded skin. The aim of the present study was to determine the effect of controlled tissue expansion on the surviving lengths of random-pattern skin flaps elevated in expanded tissue. In five pigs the surviving lengths of flaps raised in skin expanded for 5 weeks using a 250-cc rectangular Radovan-type tissue expander were compared with the survival lengths of flaps elevated in tissue in which a similar prosthesis was not expanded, bipedicle flaps delayed for 5 weeks, and control acutely raised random-pattern flaps. The expanded flaps had a mean increase in surviving length of 117 percent over control flaps, which was statistically significant. The delay flaps had an increase in survival of 73 percent over control flaps, which was also statistically significant. There was no significant difference in survival between expanded flaps and delayed flaps. Morphologic studies using radiographic techniques on one pig demonstrated increased vascularity with tissue expansion. The results of this work demonstrate that in addition to providing increased surface area with controlled expansion, flaps raised in expanded skin have a significantly augmented surviving length. The mechanism for this increased vascularity with expansion is not known at this time, but it may be due to physical forces associated with expansion acting as a stimulus for angiogenesis.

Animals↗

The "modified" winch stitch.

BACKGROUND: The methods described to achieve intraoperative tissue expansion have drawbacks. OBJECTIVE: To report an intraoperative tissue expansion technique using standard suture material and hemostats to create a "modified" winch stitch. METHODS: A continuous running suture is placed with both ends left free. A "fixed" hemostat is placed above the skin at one end. After pulling at the other end with a second hemostat, a third hemostat is placed proximal to this hemostat just above the skin, which is left in place to produce stretching. The second and third hemostats are then used in an alternating pulling and holding fashion. RESULTS: This method produces significant tissue expansion. If the desired degree of approximation is achieved, the ends of the suture can be tied together, as in the previously described winch stitch. CONCLUSION: The modified winch stitch is a simple and inexpensive means to facilitate closure of wounds under a significant amount of tension.

Humans↗

Tissue-specific expansion of uridine pools in mice. Effects of benzylacyclouridine, dipyridamole and exogenous uridine.

The concentration of uridine (Urd) in murine tissues appears to be controlled by Urd catabolism, concentrative Urd transport, and the non-concentrative, facilitated diffusion of Urd. Previous reports document the tissue-specific disruption of these processes, and subsequently intracellular pools of free Urd in mice, by the administration of exogenous Urd (250 mg/kg) or the Urd phosphorylase (EC 2.4.2.3; uracil:ribose-1-phosphate phosphotransferase) inhibitor 5-benzylacyclouridine (BAU) (240 mg/kg). We now report the effect of combinations of BAU (120 mg/kg, p.o.), the nucleoside transport inhibitor dipyridamole (DP) (25 mg/kg, i.p.), and exogenous Urd (250 mg/kg, i.v.) on Urd pools in mice. This dose of BAU increased Urd pools 2- to 6-fold, in a tissue-specific manner, for up to 5 hr. DP increased Urd pools 3-fold in spleen, over a 4-hr period, but did not affect other tissues. Administration of BAU 1 hr prior to exogenous Urd resulted in a 50- to 100-fold expansion of tissue normal after 6 hr. Administration of DP 1 hr prior to exogenous Urd caused a tissue-specific 40- to 100-fold increase in Urd pools which, except in spleen, returned to normal within 2 hr. The marked additive effects of these combinations were in contrast to those obtained following the administration of BAU 1 hr prior to DP. This regimen increased Urd pools from 4- to 9-fold, in a tissue-specific manner. In addition, Urd pools remained elevated for up to 9 hr, except in spleen where the Urd concentration was elevated for up to 15 hr. Analysis of enzyme activities indicated that DP does not enhance the inhibitory effect of BAU against murine liver Urd phosphorylase. However, DP did inhibit plasma clearance of BAU, and this effect may partially explain the apparent synergistic effect of this combination. In spite of the prolonged and dramatic expansion of tissue Urd pools produced by BAU + DP, the total Ura nucleotide content in spleen, gut and colon tumor 38 (CT38) increased by less than 70% over a 12-hr period following administration of this combination. These findings are discussed in light of their biochemical and therapeutic implications.

Administration, Oral↗

Minimal expansion for correction of male pattern baldness.

Tissue expansion for correction of male pattern baldness has not gained wide acceptance by patients or surgeons because of the substantial albeit temporary deformity of the expansion. Minimal expansion is an alternative. Scalp flaps can be expanded just to the point of becoming noticeable over 4 to 6 weeks followed by scalp flap transposition and easy closure of the donor site. The temporoparietal (Juri) or superiorly based (Dardour) flaps have been used unilaterally or bilaterally. The entire restoration is completed in approximately 8 weeks, is minimally deforming during the expansion phase, and does not require the patient to alter his lifestyle significantly or to go into hiding. Hair grafts, in contrast, do not begin to grow hair until 12 weeks after transplantation, and the process usually requires four sessions over an 8- to 12-month period with the patient looking temporarily variably absurd. Tissue expansion increases scalp available for flap restorations, which appear more natural than even the most well-executed hair transplants. Minimal expansion makes the process more palatable to the patient and surgeon.

Adult↗