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 667 records · Page 37Linked to original sources
PubMed1991

Circulatory and metabolic changes in expanded pig skin flaps.

To evaluate circulatory and metabolic changes in pig skin during tissue expansion, the buttock skin of 12 pigs was expanded for 5 weeks. In a second operation, island buttock flaps were elevated bilaterally. Flap temperature, laser Doppler flow (LDF), and fluorescein penetration borders were recorded. Norepinephrine infusions were given twice. After cannulation of the external iliac veins, the total venous outflow from the flaps and metabolic parameters such as glucose and oxygen consumption and lactate production were measured bilaterally. No significant difference in fluorescein staining was found, but laser Doppler flow in the expanded tissue was higher than in nonexpanded skin, whereas the total flap blood flow was not significantly different. A flow reduction was seen in expanded flaps during norepinephrine infusion, whereas nonexpanded flaps showed a slightly increased blood flow. This adrenergic supersensitivity indicates that it is possible that not only surgical nerve section but also tissue expansion can result in sympathetic denervation. No differences in the metabolic parameters were observed.

Animals↗
PubMed1990

Successful preexpansion of a free scapular flap.

The use of pretransfer tissue expansion of a free scapular flap is described. This technique allows coverage of large defects with good quality skin and tensionless closure of the donor site.

Adolescent↗
PubMed1993

Breast reconstruction at a district general hospital.

Breast reconstruction is normally carried out by plastic surgeons, but the advent of permanent tissue expanders places post-mastectomy reconstruction within easy reach of the general surgeon. Nineteen patients underwent breast reconstruction between 1989 and 1991 using a subpectoral silicone-based, double lumen tissue expander. Assessment of results was by: (a) patient completed questionnaire; and (b) third party evaluation of standardized photographs. The mean operating time was 58 min (40-80 min) and mean hospital stay 3 days (2-7 days). Complications included one flap necrosis and one leaking injection port. Outpatient tissue expansion required an average of seven visits (4-11) and was completed in an average of 12 months (7-19). The injection port was subsequently removed under local anaesthetic as a day case. The fully dressed appearance following reconstruction was graded good or excellent by 100% of patients and in over 80% of third-party assessments. Equivalent figures for the appearance when wearing a bra were 93% and 60% and undressed 57% and 47%, respectively. All patients recommended the procedure but 25% found inflation uncomfortable. Subpectoral tissue expansion is a safe, cosmetically acceptable method of breast reconstruction which is associated with a high level of patient satisfaction.

Breast↗
PubMed1992

Breast reconstruction with tissue expanders: obtaining an optimal result.

A large personal experience with breast reconstruction using tissue expanders (149 patients with Radovans, and more than 150 patients with Beckers), with many suboptimal results especially in the early learning stages, has brought about changes in approach offering a much higher probability of acceptable breasts. This report attempts to combine multiple factors useful in yielding such results. Areas addressed include immediate versus delayed reconstruction, selection of candidates, selection of expander type, appropriate placement of expander at a site minimizing the requirement for pocket modification, choosing the optimal size expander, importance of maximal overexpansion to yield a good submammary fold, and means of determining adequate overexpansion to match an unmodified contralateral breast and the risks inherent in overexpansion. Timing, interval, and length of maintenance of hyperexpansion are described along with deflation and timing of port removal. Both the skate and star techniques of nipple and areolar reconstruction in the hyperexpanded patient yield very acceptable results despite thinned skin and minimal subcutaneous tissue. Good, satisfactory, and suboptimal clinical results will be presented. In our experience, tissue expansion reconstruction offers distinct advantages in a large majority of patients with the proviso that patients are willing to accept the time required for hyperexpansion and the waiting period for deflation.

Female↗
PubMed1993

Scrotal construction by expansion of labia majora in biological female transsexuals.

Construction of male genitalia in biological female transsexual patients is problematic. We report 3 transsexuals with scrotal construction by tissue expansion of the labia majora. In each patient, tissue expanders were inserted into the labia majora several months before free flap phalloplasty. In 2 patients, the tissue expanders were removed, and testicular implants were placed into the labial pockets. In the other patient, the tissue expanders were left in place. Because of the close embryological relationship between the labia majora and the scrotum, the neoscrotum appears natural in color match, hair pattern, and skin texture. The anatomical position of the labia majora produces a scrotum properly located in relation to surrounding anatomical structures. Excellent aesthetic results can be achieved with this procedure. Based on our experience, we advocate this procedure for scrotal construction in biological female transsexual patients.

Adult↗
PubMed2000

Histomorphologic changes of hair follicles in human expanded scalp.

To obtain information about changes that occur in hair follicles when tissue expansion is performed on the scalp, punch biopsy samples were taken from normal scalp (stage I) and the top of the expander immediately before removal (stage II) and 12 weeks after the second operation (expander removal and flap transposition, stage III) in 10 consecutive patients. We compared histologic and quantitative changes of hair follicles in transverse sections of the expanded scalp and long-term changes with those in normal controls using three specimens from each patient. Both the proportion of terminal hair to vellus hair and the proportion of anagen hair to telogen hair were significantly increased during stages II and III (p < 0.05). Perifollicular inflammation and fibrosis were observed during stage II but disappeared during stage III. All these findings imply that tissue expansion at the hair-bearing scalp made the telogen period short, possibly because of active epidermal mitosis.

Case-Control Studies↗
PubMed1989

Lidocaine permeability in silicone tissue expanders: an in vitro analysis.

Tissue expansion has achieved a prominent role in soft-tissue reconstruction. Expansion-induced pain is often a limiting factor in this process and can affect patients for as long as 24 to 48 hours following each expansion session. Although lidocaine is known to be an effective analgesic, only anecdotal reports of its usefulness when placed within a tissue expander currently exist. This two-part study was designed first to determine if in fact silicone is readily permeable to lidocaine, and second to determine if the potential diffusion dynamics can be defined. In part 1 of the study, the silicone polymer was indeed found to be readily permeable to lidocaine as measured with fluorescence immunoassay technique. In part 2, two groups of Surgitek and Dow Corning expanders were filled with saline and lidocaine and placed in saline baths. At several intervals over a 48-hour period, aliquots of the surrounding saline were sampled and the lidocaine levels subsequently determined. A rather predictable and consistent diffusion curve was demonstrated. The significant difference in diffusion characteristics between the two expander types was apparently due to wall thickness differences inherent in the manufacturing. In this in vitro study, filler-valve leakage did not significantly contribute to lidocaine migration from within these tissue expanders. This basic in vitro work will now set the stage for further in vivo and clinical investigations to more precisely define the role of lidocaine in the tissue-expansion process.

Lidocaine↗
PubMed1992

Vulva reconstruction with a tissue expander.

A patient with exstrophy of the bladder in whom we performed vulva reconstruction using a tissue-expansion technique and local flaps was presented. The ultimate result was in concert with the anatomic characteristics of normal external genitalia with regard to type of skin, pigmentation, hair pattern, quality of circulation, and sensory supply.

Adult↗
PubMed1993

The permeability of tissue expanders to bacteria: an experimental study.

Infection is an occasional but serious complication of tissue expansion. Bacteria in many cases are found both inside and outside the expander. The mechanism of how they spread inside and out is not fully understood. In the current study, we have assessed both the expander membranes (n = 28) and the port (n = 42) in terms of leakage and transmission of Staphylococcus aureus in normal expansion (100 percent) and overexpansion (400 percent) in an in vitro model. Our results indicate that the membrane was impermeable to S. aureus, whereas the bacteria were able to migrate freely through the puncture sites in the ports.

Cell Membrane Permeability↗
PubMed2004

The effect of radiotherapy on the use of immediate breast reconstruction.

BACKGROUND: Immediate breast reconstruction techniques include tissue-expansion, latissimus dorsi flap with or without an implant, pedicled TRAM flap and free tissue-transfer. Adjuvant radiotherapy decreases loco-regional recurrence and increases overall survival. Radiotherapy in the presence of a tissue-expander or an implant can lead to an increased number of complications and poor cosmetic outcome. AIM OF THE STUDY: To study the relationship between radiotherapy and the choice of the immediate breast reconstruction technique in view of the increased number of breast cancer patients receiving adjuvant radiotherapy. PATIENTS AND METHODS: An audit of 121 patients who had immediate breast reconstruction over a period of 2 years was reviewed retrospectively. In March 1998, the radiotherapy protocol was revised. Forty-two patients operated on between January 1997 and March 1998 were compared to 79 patients operated on between April 1998 and June 1999. RESULTS: The percentage of patients receiving adjuvant radiotherapy increased in the second period as well as the proportion of autologous breast reconstruction. A small percentage of patients required unexpected radiotherapy after insertion of tissue expanders, due to narrow excision margins or unexpected pathology. Only two patients had tissue-expansion although radiotherapy was likely. CONCLUSION: The choice of the immediate breast reconstruction technique was satisfactory in most patients. The use of implants is best avoided in patients who may require adjuvant radiotherapy. Autologous immediate breast reconstruction, either free or pedicled flaps, is a safer choice for those patients.

Breast Implants↗
PubMed2001

Complications of postmastectomy breast reconstructions in smokers, ex-smokers, and nonsmokers.

Smoking results in impaired wound healing and poor surgical results. In this retrospective study, we compared outcomes in 155 smokers, 76 ex-smokers, and 517 nonsmokers who received postmastectomy breast reconstructions during a 10-year period. Ex-smokers were defined as those who had quit smoking at least 3 weeks before surgery. Transverse rectus abdominis musculocutaneous (TRAM) flap surgery was performed significantly less often in smokers (24.5 percent) than in ex-smokers (30.3 percent) or nonsmokers (39.1 percent) (p < 0.001). Tissue expansion followed by implant was performed in 112 smokers (72.3 percent), 50 (65.8 percent) ex-smokers, and 304 nonsmokers (58.8 percent) (p = 0.002). The overall complication rate in smokers was 39.4 percent, compared with 25 percent in ex-smokers and 25.9 percent in nonsmokers, which is statistically significant (p = 0.002). Mastectomy flap necrosis developed in 12 smokers (7.7 percent), 2 ex-smokers (2.6 percent), and 8 nonsmokers (1.5 percent) (p < 0.001). Among patients receiving TR4AM flaps, fat necrosis developed in 10 smokers (26.3 percent), 2 ex-smokers (8.7 percent), and 17 nonsmokers (8.4 percent). Abdominal wall necrosis was more common in smokers (7.9 percent) than in ex-smokers (4.3 percent) or nonsmokers (1.0 percent). In this large series, tissue expansion was performed more often in smokers than was autogenous reconstruction. Complications were significantly more frequent in smokers. Mastectomy flap necrosis was significantly more frequent in smokers, regardless of the type of reconstruction. Breast reconstruction should be done with caution in smokers. Ex-smokers had complication rates similar to those of nonsmokers. Smokers undergoing reconstruction should be strongly urged to stop smoking at least 3 weeks before their surgery.

Adult↗
PubMed1993

Skin expansion. Long term follow up of complications and costs of care.

To find out our rate of complications after tissue expansion, and the cost of treatment in terms of use of hospital resources and length of sick leave, we analysed our experience of 181 expansion treatments in 97 patients undertaken between 1986 and 1991. There were 60 women and 37 men, with a mean age of 22 (range 1-74). Twenty patients had more than one period of treatment (range 2-8). The most common conditions treated were naevi (n = 75); scars (trauma--n = 33, burns--n = 17, and operations--n = 16); and breasts that required reconstruction (n = 15). Of the 181 expansions there were 29 failures (16%), and 117 complete successes (64%); fifteen of the latter developed minor complications (8%), 35 were partly successful (20%). There were 77 complications in 71 treatments (38%), and 45 expanders (25%) had to be removed prematurely because of complications. The most common complications were skin penetration (n = 15), minor infection (n = 13), and breakdown of the surgical wound (n = 13). The median (range) inpatient hospital stay was 8 days (2-39); number of visits to the outpatient clinic for filling 7 days (0-20); and total treatment time/patient 82 (19-286). We conclude that skin expansion is a useful technique, but that there is room for improvement in reducing the rate of complications and the amount of time that patients spend being treated.

Absenteeism↗
PubMed2006

Implant reconstruction in breast cancer patients treated with radiation therapy.

BACKGROUND: Implant reconstruction in breast cancer patients treated with radiation therapy is controversial. Prior studies are limited by older prosthetic devices, reconstructive techniques, and radiation therapy protocols. METHODS: A retrospective review was performed of patients who underwent tissue expansion and implant breast reconstruction performed by a single surgeon after mastectomy for breast cancer from 1996 to 2003. Complications and aesthetic results were compared between patients who received radiation therapy and those who did not. RESULTS: A total of 104 patients (123 breasts) who underwent mastectomy and implant breast reconstruction were included in the study. Twenty-seven patients (27 breasts) received either premastectomy or postmastectomy radiation therapy for breast cancer. All patients who received radiation therapy did so before completion of their implant reconstruction. Complications ultimately requiring prosthetic device removal or replacement, as well as total complications (those requiring prosthetic removal or replacement and those not requiring prosthetic removal or replacement), were more frequent in breasts that received radiation than breasts that did not (18.5 percent versus 4.2 percent for complications requiring prosthetic removal or replacement, p < or = 0.025, and 40.7 percent versus 16.7 percent for total complications, p < or = 0.01). Breast symmetry was significantly better in patients who did not receive radiation compared with those who did (p < 0.01). CONCLUSIONS: Implant breast reconstruction in patients who receive radiation therapy is possible but associated with more frequent complications and decreased aesthetic results. However, the present results compare favorably to those reported in prior studies. Improved results in the present study may be attributable to the use of newer prostheses, staged breast reconstruction with initial tissue expansion, total muscular coverage of the implant, and modern radiation therapy protocols.

Adult↗
PubMed1998

Electroneurography during facial nerve expansion.

With the use of tissue-expansion techniques, it is possible to elongate the facial nerve without impairing its function. The rate of expansion is limited by ischemic events imposed by stretching of the nerve and by anatomic characteristics of the nerve segment. In this study, we used various electroneurography techniques to determine the first sign of facial dysfunction during expansion. The main objective of the study was to ascertain test-retest variability of electroneurography techniques. Facial nerves were expanded in 16 cats with the use of a tissue expander secured more deeply to the main trunk. We conducted electroneurography measurements with the use of surface electrodes, temporary needle electrodes, and permanently implanted electrodes. Technique-dependent variations encountered with the surface electrodes made this method unreliable. Using implanted electrodes, we noted gradual worsening of the compound-action potential amplitude with increasing expansion. During acute expansion, reduction in compound-action potential amplitude was correlated with clinically observed deterioration of facial-nerve function. In this study, electroneurography with implanted electrodes was found to be the most reliable predictor of the rate of successful facial nerve expansion.

Action Potentials↗
PubMed1993

Tissue expanders in the lower face and anterior neck in pediatric burn patients: limitations and pitfalls.

Radovan's 1982 landmark work on the clinical use of tissue expanders was felt to be a panacea for multiple reconstructive problems. We have used and probably overused tissue expanders for reconstruction of many complicated pediatric facial burn problems. This has enlightened us to some of the limitations of their use, and we have, therefore, reassessed our indications for their use. From 1984 through 1990, 52 tissue expanders were used in 37 pediatric patients for face and anterior neck burn scar resurfacing. This experience, combined with the unique problems encountered with face and neck tissue expansion, provided the groundwork for operative guidelines. The long-term effects of gravity, growth, and scarring on facial features adjacent to expanded skin led to the following principles. (1) Caution should be used in advancing expanded neck skin beyond the border of the mandible. The risk of scar widening or possible lip or eyelid ectropion needs to be considered when planning these flaps. Extreme overexpansion is necessary to advance unburned neck flaps over the mandibular border to avoid these problems. (2) After advancement or rotational flaps neck flaps to the face, vertically directed suture lines in the neck may need redirection to prevent linear contracture. This correction may be performed during the primary operation or during revisions. (3) Expanded cheek or neck skin should preferably replace burned areas, but at the same time, not violate unburned facial aesthetic units. (4) To counteract the affects of gravity, expanded cheek skin in conjunction with expanded neck skin, if unburned, may be the best choice for face or mandibular border scar replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Experience with an external valve in small volume tissue expanders.

Tissue expansion has been a reconstructive technique for nearly 10 years. All published work has described serial expansion by percutaneous injection into a buried reservoir. This paper reviews a small series of patients who had tissue expansion using small volume expanders with an external valve. The complications with small expanders are discussed. The external valve is shown to be satisfactory and free from infection in this series.

Adult↗
PubMed2003

Long-term follow-up and unusual findings after microvascular transfer of hair-bearing skin for pubic hair restoration.

Alopecia in the pubic area can be restored successfully with hair transplantation using minigrafts and micrografts or with free tissue transfer of a hair bearing flap. In this report the authors present the successful transfer of hair bearing tissue from the temporoparietal scalp for the correction of a congenital form of alopecia of the pubic region. In addition, they present long term results of this transfer. Auxiliary procedures such as tissue expansion before or after transferring the flap, hair epilation and minigraft and micrograft transplantation could help to achieve a more natural result. Tissue expansion of the donor site could also be performed to enhance the outcome of the procedure. Of note is the rapid rate of hair growth in the transplanted tissue. This type of reconstruction using a hair bearing temporoparietal flap for restoration of hair to the pubic region is a useful method that can yield good results.

Adult↗