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Results for “Tissue Expansion”

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At least 649 records · Page 36Linked to original sources

PubMed2000

Use of tissue expanders with external ports.

The high number of reconstructive dilemmas brought about by more aggressive treatment of congenital malformations and burns has created the need for large quantities of donor skin for local coverage. Tissue expansion with external ports has become part of the authors' surgical armamentarium. From January 1996 to November 1998 the authors placed 34 expanders in 28 patients to correct congenital malformations or burn sequelae. The average patient age at the time of operation was 6.3 years, the average time of expansion was 49 days, and minimal and maximal expansion volume was 60 and 600 cc respectively. Serial injection was carried out every 2 days until total expansion was achieved, and the expanded area was two to three times as wide as the recipient defect. No major complications occurred. The most serious complications of infection and erosion of tissue overlying the device occurred in 17.6% of patients. There are several advantages to this technique: less tissue dissection, painless injections, shorter operating time, and early detection of leaks. Lozano ST, Drucker MZ. Use of tissue expanders with external ports.

Adolescent↗

PubMed1993

Fixed membranous bone graft survival after recipient bed alteration.

The effectiveness of membranous bone grafting in craniofacial reconstruction is hindered by resorption. The aim of this study was to determine whether alterations of the recipient bed through tissue expansion affect membranous bone graft survival. Eighteen adult rabbits were divided into three groups. Group I rabbits (control) received fixed autologous membranous bone grafts to their snouts. Group II rabbits had self-inflating tissue expanders inserted over their nasal dorsum, inflation for 3 weeks, and then expander removal and placement of fixed autologous membranous bone grafts to their snouts. Group III rabbits varied from group II by delaying bone grafting until 2 weeks after expander removal. One animal from each group was killed at post-grafting days 15 and 45, the remainder at day 90. Results were assessed by volumetric, nondecalcified histologic, and stereologic analysis. Volumetrically, group I grafts demonstrated 82 percent survival, whereas group II demonstrated 101 percent (p = 0.029) and group III 94.5 percent (p = 0.21). Histologically, group I grafts exhibited greater loss (i.e., porosity and resorption) and less labeling activity. Groups II and III showed extensive evidence of trabecularization and incorporation at the graft-host interface. Stereologic measurements such as osteoid seam width (OSW) confirmed the greater survival and activity of groups II and III bone grafts. Group II OSW measured 12.4 microns, group III 12.0 microns, and group I 9.8 microns (p = 0.04). Stereology also demonstrated that groups II and III's OSW approached that of the recipient bed and contralateral zygoma, whereas group I did not (p = 0.029), suggesting an integration of the graft and host architectures.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2001

Growth in width of the metacarpals--an investigation in human fetuses.

The process of growth in width of the human hand during fetal life has never been described. Do metacarpals grow concentrically and separation between the bones occurs through expansion of soft tissues? Or is growth eccentric, a process termed drift by Enlow, a relocation in space of organs? Hands of 10 spontaneously aborted fetuses (age range: between 14.5 and 24 weeks of gestation) were examined paying special attention to the bone bark. A thicker bone bark was taken as an indication of growth in that direction. The thickness of the bone bark was measured at the radial and ulnar sides at the level of the proximal and of the distal physes of the second to fifth metacarpals. A ratio of radial over ulnar bone bark thickness (R/U ratio) was calculated. The third metacarpal grew almost concentrically (R/U ratio 1.12 +/- 0.06). The second metacarpal grew in a radial direction (R/U ratio 3.29 +/- 0.19) and the fourth and more so the fifth metacarpal grew in an ulnar direction (R/U ratio 0.70 +/- 0.04 and 0.42 +/- 0.02, respectively). The differences in R/U ratios between every metacarpal were statistically significant for all comparisons P < or = 0.001. Fetal growth in width of the human metacarpals is eccentric and not concentric. It is concluded that during growth in width the metacarpals move away from the midline of the hand and that growth occurs through eccentric bone apposition rather than through soft tissue expansion.

Anthropometry↗

PubMed1991

Oblique facial cleft with anophthalmia in a mentally normal child.

An oro-ocular facial cleft with anophthalmia, classified as Tessier cleft no. 4, was satisfactorily corrected by a series of conservative procedures, including tube pedicle flap transfer, Z plasties, and bone grafting for orbital socket and zygomatic reconstruction. Beginning in 1975 when the patient was 4 months old, most of the reconstructions were performed before the routine tissue expansion and microsurgical tissue transfer techniques that are common today. The patient's development is normal and he is intellectually more advanced than most children his age. Correction of increasing asymmetry between growing and nongrowing regions of the skull in this young boy will probably be required.

Abnormalities, Multiple↗

PubMed1992

Extensive scalp lifting as a reconstructive tool for a large scalp defect.

Extensive scalp lifting is a relatively new technique for the treatment of alopecia. Because this technique involves the undermining of the entire occipitoparietal scalp down to the hairline of the nape, a significant anterior and medial advancement is accomplished with one operation. This case report describes a patient with a large surgically induced scalp defect that was reconstructed with the use of extensive scalp lifting in combination with coronal brow lifting--thus, the intermediate cosmetic deformity of the more commonly used tissue expansion technique was completely circumvented. Why this technique can be substituted for tissue expansion or multiple rotation-transposition flaps in certain cases in elaborated.

Alopecia↗

PubMed1995

Potential roles of apoptosis in viral pathogenesis.

Apoptosis is a physiologic mechanism of cell death that is induced during development or reversible tissue expansion or after tissue damage to eliminate unwanted cells. Recently, viral gene products have been shown to either specifically induce or specifically inhibit apoptosis. In this review, our current understanding of the regulation of apoptosis is outlined. The mechanisms by which viruses can inhibit or induce apoptosis are described. The role of apoptosis in modulating the immune response to viral infection is discussed. Finally, the hypothesis is advanced that the balance between induction and inhibition of apoptosis is modulated by viruses to optimize the course of viral infection.

Animals↗

PubMed2001

Close-range shotgun and rifle injuries to the face.

The treatment of extensive shotgun and rifle injuries to the face is extremely difficult and demands experience in microsurgery and craniofacial surgery. Early aggressive surgery with immediate bone and soft tissue reconstruction is recommended for the management of extensive facial gunshot wounds. Experience has shown that early three-dimensional bone replacement can be achieved with bone grafts in the midfacial area if the bone grafts are covered with well-vascularized tissues. Large midfacial defects can be reconstructed safely and effectively with free-tissue transfers, including bone. In the acute stage, microvascular muscle flaps are preferred because of their good vascularity and good filling capacity. These flaps are able to cover the anterior cranial fossa. When vascularized bone is needed, the authors' first choice is a latissimus dorsi flap with scapular bone. Patients treated with an early and aggressive surgical strategy develop fewer problems in form of infection, contraction, scarring, and require fewer secondary corrections. Successful primary treatment allows the surgeon to use multiple modalities, including tissue expansion, free-tissue transfers, and local flaps in a noninfected environment. The treatment is rewarding, and the results are surprisingly good. It is extremely unusual for patients with self-inflicted gunshot injuries to reattempt suicide.

Adolescent↗

PubMed1997

Concepts in neck reconstruction.

This article reviews the principles and techniques of reconstructing soft-tissue defects of the neck. The various surgical techniques, including local rotational flaps, tissue expansion, and free tissue transfer, are reviewed, and considerations in the selection of surgical techniques are discussed.

Humans↗

PubMed1996

Tissue expanders in syndactyly: a brief review.

Tissue expansion has been advocated as a method of obtaining enough skin to correct syndactyly without using skin grafts. However, results have been disappointing, indications are unclear, and complication rates are still relatively high. We review the published cases of syndactyly treated with tissue expansion, acknowledging the lack of data and guidelines for its use in such condition. After more than 10 years since its introduction in the treatment of syndactyly, its use is still not as widespread as one would have been led to expect.

Humans↗

PubMed1988

Comparative viability of expanded and unexpanded axial pattern skin flaps in pigs.

A comparison of viable areas of axial pattern flaps post inset was made between expanded and non-expanded pig buttock island flaps. The deep circumflex iliac artery and vein supply approximately the proximal 14 x 10 cm area of this flap. Larger flaps were raised on expanded and control sides of eight pigs to determine if expansion increased the area of survival. In six of eight pigs whose initial tissue expansion did not create more than approximately a 50% increase in skin area, the expanded flaps had a statistically significant increase in viable skin area (proportionally) 10 days post inset than their control flaps (p less than 0.05). Two other pigs did not conform to this pattern. Their initial tissue expansion was greater than 50%, and the resulting area of flap viability was proportionally less in expanded flaps than the control flaps.

Animals↗

PubMed1997

A method of breast reconstruction with a deepithelialized TRAM flap via the abdominal approach for failed implant salvage in postmastectomy patients.

Postmastectomy reconstruction of breasts is one of the most commonly performed procedures of the plastic surgeon today. Tissue expansion with subsequent implant placement, transverse rectus abdominis musculocutaneous (TRAM) flaps, latissimus dorsi flaps, gluteal flaps, Ruben's fat pad flaps, and free flaps from other areas have all been utilized with consistently good aesthetic results. One special class of patient is the woman who has undergone breast reconstruction with tissue expansion, with or without subsequent implant placement, who than receives external beam radiation therapy. Capsular contraction frequently complicates this therapy. In the past, women have undergone capsulotomy or capsulectomy with replacement of the implant. Recently, women are more reluctant to have foreign tissue in their bodies and are opting for autologous tissue reconstructions. TRAM reconstruction following removal of implants has been previously reported. A new approach to the placement of the TRAM flap after implant reconstruction via the abdominal approach, with avoidance of any incision on the breast itself, is presented. This is especially important in a patient who has evidence of radiation damage to the skin, placing any incision through the treated tissue at risk.

Breast Implants↗

PubMed1987

A method of reconstructing a pendulous breast utilizing the tissue expander.

It is possible to reconstruct a breast mound of almost any size by utilizing tissue expansion. In order to produce a pendulous breast which is also ptotic, the tissue-expansion technique has been combined with two other procedures. A new technique is being introduced. It is that of elevating the lower third of the mature breast capsule surrounding the tissue expander at the time the permanent prosthesis is to be exchanged for the expander. The established techniques of inframammary fold reconstruction of Pennisi and Ryan are used to provide pedicle skin coverage for the undersurface of the breast and the bed of the elevated capsule. Internal and external surgical approaches are described, and two examples of each are illustrated. Breasts reconstructed in this manner have remained pendulous structures. Some loss of the initial degree of ptosis has been noted in some cases.

Breast↗

PubMed1989

[Expansion prostheses in restorative and esthetic surgery of the head].

The authors discuss the results of 29 cases of tissue expansion, using 40 expanders, at the head and neck level, in an attempt to achieve a constructive self-criticism. The results have been classified into excellent (18 over 28 cases), good (4/29), fair (3/29) and poor (4/29). Complications were those usually reported: pain, infection, wound dehiscence, reservoir failure. In summary, 23 of 29 patients have definitely gained from tissue expansion. The remaining 6 cases considered as failures are carefully discussed leading to some practical conclusions.

Adolescent↗

PubMed2000

Effect of intraperitoneal pressures on tissue water of the abdominal muscle.

A major factor that affects solute and water transport through tissue is the state of tissue hydration. The amount of interstitial water directly affects the transport coefficients for both diffusion and convection. To investigate the effect of simultaneous exposure of tissue to hydrostatic and osmotic pressures on the state of tissue hydration and the pattern of distribution of tissue water, we dialyzed rats with isotonic (290 mosmol/kg) or hypertonic (510 mosmol/kg) solution at intraperitoneal pressures (P(ip)) between 0 and 6 mmHg, and we infused isotopic markers intravenously and determined their equilibrium distribution volumes (V(D)) in the anterior abdominal muscle (AAM) by quantitative autoradiography. Total tissue water volume (theta(TW)) was determined from dry-to-wet weight ratios. theta(urea), the V(D) of [(14)C]urea, equals the sum of the extracellular water volume (theta(EC), V(D) of [(14)C]mannitol) and intracellular water volume (theta(IC) = theta(urea) - theta(EC)). If theta(if) = interstitial water volume and theta(IV) = vascular water volume (V(D) of (131)I-labeled IgG), then theta(EC) = theta(if) + theta(IV). AAM hydrostatic pressure profiles were measured by a micropipette/servo-null system and demonstrated that elevation of P(ip) above 3 mmHg significantly (P < 0.05) increases mean tissue pressure (P(T)) to the same level regardless of intraperitoneal osmolality. The increase in P(T) resulted in a nonlinear tissue expansion primarily in the interstitium regardless of osmolality. From 0 to 6 mmHg, theta(if) (in ml/g dry tissue) increased from 0.59 +/- 0.02 to 1.7 +/- 0.05 and to 1.5 +/- 0.05 after isotonic and hypertonic dialysis, respectively, whereas theta(IC) increased from 2.8 +/- 0.08 to 3.0 +/- 0.1 after isotonic dialysis and decreased to 2.6 +/- 0.1 after hypertonic dialysis. After dialysis at 6 mmHg with isotonic or hypertonic solutions, theta(IV) increased from 0.034 +/- 0.001 to 0. 049 +/- 0.001 and 0.042 +/- 0.002, respectively. theta(urea) during hypertonic dialysis at P(ip) between 0 and 6 mmHg increased in a nonlinear fashion (F = 26.3, P < 0.001), whereas theta(IC) invariably decreased (F = 11.1, P < 0.001) and theta(if) doubled from its control value at low P(ip). In conclusion, elevation of intraperitoneal hydrostatic pressure causes tissue expansion, primarily in interstitium, irrespective of osmolality of the bathing solution. Tissue hydrostatic pressure is therefore the primary determinant of tissue properties with respect to hydration, which in turn affects diffusive and convective transport.

Abdominal Muscles↗

PubMed2000

The limitation of primary excision of cicatricial alopecia: a report of 63 patients.

This 11-year retrospective study (1985-1996) of 63 patients demonstrates that cicatricial alopecia is almost always distressing for the patient and is considered as a social handicap, which makes repair a necessity. Two major therapeutic methods for remedying this condition were used in the study: suture excision and tissue expansion. The optimal use and limitations of each method are defined on the basis of treatment quality, as evaluated by the patient and the surgeon. Suture excision often ends with disappointing results for the surgeon as well as the patient and seems limited to alopecias no greater than 10 mm in width. Tissue expansion is considered generally satisfactory, but has the problem of scar enlargement, which reduces the quality of the result.

Adolescent↗

PubMed1995

The use of tissue expanders in the correction of ectropion in an animal model.

The use of tissue expanders in eyelid reconstruction has seen limited application. To determine the efficacy of tissue expanders in the correction of cicatricial ectropion, an animal model was developed. Lower-eyelid blepharoplasty with overcorrection was performed on 18 New Zealand white rabbits. After 1 month, if significant ectropion was present, tissue expanders (1.8-cm3 Cylindrical/Microdome [CUI Corporation, Carpinteria, Calif.]) were inserted on one side, the other eye being the control. These were inflated in the following weeks to a total volume of 2 cm3. The tissue expanders were then removed, and the animals were followed for 1 month. Although the early results were encouraging, the ectropion progressed toward its preoperative severity. It appears that lower-eyelid ectropion remains a therapeutic problem that is only partially corrected with tissue expansion alone.

Animals↗

PubMed2000

Pregnancy as a tissue expander in the repair of a massive ventral hernia.

The use of tissue expanders has been described in numerous applications, including the closure of massive abdominal wall defects. The advantages of tissue expansion include providing adequate soft tissue for stable coverage of prosthetic material. In a subfascial plane, expanders can also expand muscle and fascia to allow total autologous repair of massive ventral hernias. These techniques for abdominal wall reconstruction are well established to cover viscera, to repair hernias, and to restore acceptable contour. The authors present the novel case of a woman with unstable skin graft coverage of a massive ventral hernia whose pregnancy was used as a surrogate intra-abdominal tissue expander to facilitate abdominal wall reconstruction.

Adult↗

PubMed2002

[Computer-based preoperative planning for breast reconstruction in the woman with unilateral breast hypoplasia].

BACKGROUND: Aim of this paper is to describe a computer program which can provide objective and quantitative data useful for the selection of the proper implant in order to obtain the symmetry with the contralateral breast in case of unilateral breast reconstruction by tissue expansion, especially for the surgeon without experience or for the occasional operator. METHODS: Our C++ program provides the final implant volume using the measurements of the semi-circumference and projection of the contralateral breast performed on the supine patient. The aim is the symmetry of the two breasts. RESULTS: According to our experience in breast reconstruction by tissue expanders, this program allows non invasive and simple measurements of the breast volume, useful to obtain the mammary symmetry. CONCLUSIONS: In case of breast reconstruction by tissue expansion, the preoperative evaluation is usually based on the surgeon's experience and on empirical observations without knowing the correct volume to reach. For this reason our program is useful to know the necessary volume for breast reconstruction, and therefore it allows the surgeon to obtain a better plastic result.

Adult↗