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Results for “Tissue Expansion”

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PubMed1997

[Use of iterative expansion in the early surgical treatment of complex nevi of the head in children].

Extensive of congenital pigmented nevi to the face in an infant is an indication for early exeresis to prevent the risk of degeneration. Search for the best esthetic result has led many authors to healthy skin to a maximum, often relying on tissue expansion. The aim of this study was to present the combination of two expansion techniques, prosthetic expansion and differed natural expansion. Five infants with congenital pigmentary nevi extending to more than 50% of a facial anatomic unit were treated. Total treatment was achieved in all patients with three or four procedures. By combining different expansion techniques early treatment can be proposed with good esthetic results and moderate cost.

Child↗

PubMed1989

Dendritic morphology of retinal dopamine cells in carp of different sizes.

The dendritic morphology of dopamine (DA) cells in the inner plexiform layer of the retina of different-sized carp (8.6-33.6 cm in body length) was investigated by identifying their fluorescent cell bodies in isolated, aldehyde-fixed flatmounts and injecting them iontophoretically with Lucifer yellow (LY) under microscopic control. DA cells for LY injection were chosen in an intermediate region between the optic disc and the retinal margin, and their spatial parameters (cell density, nearest neighbor distance, dendritic field size and dendritic coverage) were compared between retinas of different sizes to explore whether this region is simply stretched by tissue expansion during retinal growth. It was shown that as the fish grow larger the dendritic field size of DA cells increases while the cell density is sharply reduced and the dendritic coverage gradually decreases. Differences in the dendritic coverage of DA cells between certain fish groups with different sizes were statistically significant. Further, the irregularity in cell distribution appeared to increase as the fish became larger. These results suggest that the dendritic tree of individual DA cells in the intermediate region is developed not only by tissue expansion but also by other unknown factors.

Animals↗

PubMed2001

Giant congenital nevi: a 20-year experience and an algorithm for their management.

A variety of treatment options exists for the management of giant congenital nevi. Confusion over appropriate management is compounded because not all giant congenital nevi are pigmented, and malignant potential varies between different types. The present study sought to define factors in the presentation of giant congenital nevi that could provide an algorithm for their management, with respect to both the extent of resection and subsequent reconstructive options.A retrospective review of all patients who presented with a congenital nevus of 20 cm2 or greater since 1980 was performed, distinguishing among nevi involving the head and neck, the torso, and the extremities. Sixty-one patients with giant congenital nevi were evaluated (newborn to age 16 years), of which 60 nevi in 55 patients have been operated on. Giant congenital nevi having malignant potential were pigmented nevi (53 patients) and nevus sebaceus (four patients). Those not having malignant potential were verrucous epidermal nevi (three patients) and a woolly hair nevus (one patient). Of the 60 giant congenital nevi operated on, expanded flaps were used in 25, expanded full-thickness skin grafts were used in 10, split-thickness or nonexpanded full-thickness skin grafts were used in 13, and serial excision was used in 30. After 1989, operations tended to use multimodality treatment plans, with an increased use of expanded full-thickness grafts and immediate serial tissue expansion. The use of serial excision, particularly in the extremities, also increased after 1989. Serial excision was the treatment of choice when it could be completed in two procedures or less, which occurred in more than 80 percent of cases using serial excision alone. Expanded flaps were the most common mode of reconstruction in the head and neck region and were used in 49 percent of these procedures. Serial excision was the most common form of treatment in the extremities, used in 50 percent of procedures. Tissue expansion in the extremities was infrequently used to provide an expanded flap (8 percent of procedures), whereas it was frequently used to provide expanded full-thickness skin grafts harvested from the torso (used in 31 percent of procedures). On the basis of these data, algorithms for the extent of resection and subsequent reconstructive options for giant congenital nevi were developed. Their management should be formulated relative to pigmentation, malignant potential, and anatomic location of the respective lesions.

Adolescent↗

PubMed2006

Quantitative analysis of the reconstructed breast using a 3-dimensional laser light scanner.

Postoperative cosmesis of the reconstructed breast depends on the interrelation of shape, size (volume), and symmetry. In this study, reconstructed breasts were analyzed with 3-dimensional projections generated by laser light scanning. Fifty-one cases of breast reconstruction following mastectomy (16 cases of rectus abdominis flap, 15 cases of latissimus dorsi flap, and 20 cases of tissue expansion) were evaluated 6 months postoperatively. Shape, volume, and symmetry were quantitatively evaluated. Captured images of the normal breast were mirror-reversed and superimposed on images of the reconstructed breast. Differences in the generated Moire patterns were used to quantitatively compare breasts. The method was rapid, reproducible, and accurate in comparison to thermoplaster casts. It was found that rectus abdominis flaps applied following total mastectomy and latissimus dorsi flaps applied following partial mastectomy gave the best results for their relatively low degree of asymmetry. Application of tissue expansion led to greater asymmetry and poorer overall cosmesis. In conclusion, a 3-dimensional laser light scanning system makes it possible to quantitate the cosmetic outcome following breast reconstruction.

Adult↗

PubMedDate not supplied

Use of the expanded skin flap in esthetic reconstruction of postburn deformity.

Tissue expansion is very useful in the restoration of postburn deformities. We describe two esthetic reconstructions of postburn deformity with expanded skin flaps. In case No. 1, the patient was plagued with the pigmented skin graft used for coverage of a burn ulcer on the lateral chest. The graft was completely replaced by expanded skin flaps and esthetic improvement was obtained. In case No. 2, the patient had postburn alopecia including the right hairline and sideburn. The expanded scalp free flap harvested from the contralateral side was used and an excellent result was obtained. We submit that tissue expansion is the technique of choice for esthetic reconstruction of postburn deformities.

Adolescent↗

PubMed1991

Retardation by aminoguanidine of development of albuminuria, mesangial expansion, and tissue fluorescence in streptozocin-induced diabetic rat.

This study evaluated the relationship between the development of fluorescence related to advanced glycosylation end products (AGEs) in the kidney and experimental diabetic nephropathy over a 32-wk period. Control, untreated diabetic, and aminoguanidine-treated diabetic rats were followed for 32 wk with eight weekly measurements of urinary albumin excretion. After 32 wk, collagen-related fluorescence in aorta and kidney (whole kidney, isolated glomeruli, and renal tubules) and glomerular ultrastructure were evaluated. Diabetes was associated with a significant increase in collagen-related fluorescence in the aorta and kidney. Aminoguanidine prevented the increases in collagen-related fluorescence in aorta, isolated glomeruli, and renal tubules but not in whole kidney. Diabetes was associated with increased albuminuria, fractional mesangial volume, and glomerular basement membrane (GBM) thickness. Aminoguanidine attenuated the rise in albuminuria and prevented mesangial expansion without influencing GBM thickness in diabetic rats. The concomitant changes in collagen-related fluorescence, albuminuria, and mesangial expansion with aminoguanidine therapy are consistent with the hypothesis that AGEs may play a role in the development of diabetic nephropathy.

Albuminuria↗

PubMed2000

Action potential propagation in inhomogeneous cardiac tissue: safety factor considerations and ionic mechanism.

Heterogeneity of myocardial structure and membrane excitability is accentuated by pathology and remodeling. In this study, a detailed model of the ventricular myocyte in a multicellular fiber was used to compute a location-dependent quantitative measure of conduction (safety factor, SF) and to determine the kinetics and contribution of sodium current (I(Na)) and L-type calcium current [I(Ca(L))] during conduction. We obtained the following results. 1) SF decreases sharply for propagation into regions of increased electrical load (tissue expansion, increased gap junction coupling, reduced excitability, hyperkalemia); it can be <1 locally (a value indicating conduction failure) and can recover beyond the transition region to resume propagation. 2) SF and propagation across inhomogeneities involve major contribution from I(Ca(L)). 3) Modulating I(Na) or I(Ca(L)) (by blocking agents or calcium overload) can cause unidirectional block in the inhomogeneous region. 4) Structural inhomogeneity causes local augmentation of I(Ca(L)) and suppression of I(Na) in a feedback fashion. 5) Propagation across regions of suppressed I(Na) is achieved via a I(Ca(L))-dependent mechanism. 6) Reduced intercellular coupling can effectively compensate for reduced SF caused by tissue expansion but not by reduced membrane excitability.

Action Potentials↗

PubMed2006

Dynamic changes of cardiac conduction during rapid pacing.

Slow conduction and unidirectional conduction block (UCB) are key mechanisms of reentry. Following abrupt changes in heart rate, dynamic changes of conduction velocity (CV) and structurally determined UCB may critically influence arrhythmogenesis. Using patterned cultures of neonatal rat ventricular myocytes grown on microelectrode arrays, we investigated the dynamics of CV in linear strands and the behavior of UCB in tissue expansions following an abrupt decrease in pacing cycle length (CL). Ionic mechanisms underlying rate-dependent conduction changes were investigated using the Pandit-Clark-Giles-Demir model. In linear strands, CV gradually decreased upon a reduction of CL from 500 ms to 230-300 ms. In contrast, at very short CLs (110-220 ms), CV first decreased before increasing again. The simulations suggested that the initial conduction slowing resulted from gradually increasing action potential duration (APD), decreasing diastolic intervals, and increasing postrepolarization refractoriness, which impaired Na(+) current (I(Na)) recovery. Only at very short CLs did APD subsequently shorten again due to increasing Na(+)/K(+) pump current secondary to intracellular Na(+) accumulation, which caused recovery of CV. Across tissue expansions, the degree of UCB gradually increased at CLs of 250-390 ms, whereas at CLs of 180-240 ms, it first increased and subsequently decreased. In the simulations, reduction of inward currents caused by increasing intracellular Na(+) and Ca(2+) concentrations contributed to UCB progression, which was reversed by increasing Na(+)/K(+) pump activity. In conclusion, CV and UCB follow intricate dynamics upon an abrupt decrease in CL that are determined by the interplay among I(Na) recovery, postrepolarization refractoriness, APD changes, ion accumulation, and Na(+)/K(+) pump function.

Action Potentials↗

PubMed1999

Hydrostatic and osmotic pressures modulate partitioning of tissue water in abdominal muscle during dialysis.

OBJECTIVES: To investigate the effect of simultaneous exposure of anterior abdominal muscle (AAM) to changes in intraperitoneal hydrostatic pressure (Pip) and to osmolality of peritoneal fluid on total tissue water (TTW) and on the pattern of distribution of TTW in the AAM. DESIGN: A pilot study of single 60-min dwells in anesthetized Sprague-Dawley (SD) rats, dialyzed with either isotonic (290 mOsm/kg) or hypertonic (510 mOsm/kg) dialysis solutions at nominal Pip of 0 mmHg or 6 mmHg. MEASUREMENTS: TTW (from dry-weight-to-wet-weight ratios) can be divided into the extracellular volume [theta(ec), from quantitative autoradiography (QAR) with 14C-mannitol] and intracellular volume (theta(ic) = TTW - theta(ec)). Theta(ec) = theta(if) + theta(iv), where theta(if) = interstitial volume and theta(iv) = vascular volume [from QAR with 131I-immunoglobulin G (IgG)]. All measured parameters are standardized to tissue dry weight and expressed as mean +/- standard error. RESULTS: Regardless of the osmolality of the dialysis solution, elevation of Pip to 6 mmHg results in tissue expansion, primarily in theta(if), which is doubled to 1.71+/-0.11 mL/g dry weight and 1.60+/-0.17 mL/g dry weight with isotonic and hypertonic dialysis, respectively, as compared to controls (0.64+/-0.04 mL/g dry weight). The local theta(iv) was not affected by Pip or osmolality of the bathing solution. The overall theta(iv) is 0.046+/-0.006 mL/g dry weight. A two-way analysis of variance (ANOVA) to access the effect of osmolality and Pip on theta(ic) demonstrated no significant change in theta(ic) (F = 1.2, p > 0.1) as calculated for controls (3.13+/-0.19 mL/g dry weight), after isotonic dialysis (3.13+/-0.20 mL/g dry weight), or after hypertonic dialysis (2.77+/-0.30 mL/g dry weight). CONCLUSION: Elevation of Pip to 6 mmHg significantly increased TTW and expanded the tissue. Tissue expansion is primarily in interstitium (theta(if)), which is doubled from control value regardless of dialysis fluid osmolality.

Abdominal Muscles↗

PubMed1997

Plasticity of the extracranial facial nerve.

Although the expansion properties of peripheral nerves have been a matter of considerable study in recent years, investigations of the plasticity of cranial nerves, including the facial nerve, have been lacking. Clinicians, however, have long recognized the tenacity of facial nerve function in patients with slow-growing benign tumors that enormously distort the nerve. An experimental study was designed to assess whether tissue expansion techniques can be applied to the extracranial portion of the facial nerves of cats. In eight cats the frontozygomatic branch of the facial nerve was expanded by stages in seven sessions over a period of 40 days. The length of the nerve increased an average of 95% without significantly impairing nerve function. Pressure changes in the expander averaged 75 mm Hg during each stage of expansion. Electroneurography was performed after each injection of the expander. Statistical analysis of these data did not show consistent evidence of demyelination or denervation, and all but one cat exhibited a normal blink reflex and had normal electromyographic findings at the end of the experiment. Histologic examination of the expanded nerves, however, did show inflammatory changes, intraneural edema, and occasional demyelination.

Animals↗

PubMed2002

[The influence of expansion maintenance period upon in vivo skin tension and immediate stretch-back rate of the expanded skin].

OBJECTIVE: The study was to investigate the influence of maintenance period of expansion upon skin tension and immediate stretch-back rate of the expanded skin. METHODS: 30 expanders (240 ml) were implanted in six adult dogs, which were divided into four groups: group A with 2-week saline injection of the expander; group B with 6-week injection; group C with sham-operation and group D as the blank control group. The first two groups were subdivided into three groups respectively according to different maintaining times of one week, two weeks and four weeks. When full inflation was finished, a 4 cm x 7 cm expanded flap was created and in vivo skin tension and stretch-back ratio of the flap were measured. The Comparison was made in terms of in vivo skin tension and immediate stretch-back ratio between different injection and different maintenance periods. RESULTS: With expansion maintenance time increasing, the in vivo skin tension and immediate stretch-back ratio decreased. After the capsule of the expand skin flap was removed, the in vivo skin tension and immediate stretch-back rate significantly reduced. Based on the experimental results, 16 patients were treated with implantation of 23 expanders. Their average expander injection time was 14 days and the average maintenance time was 25 days. All expanders obtained good results except one extrusion. CONCLUSION: In skin and soft tissue expansion, in vivo skin tension and immediate stretch-back ratio can be reduced through prolonged maintenance of expansion and capsule removal from the expanded skin flap.

Adolescent↗

PubMed2002

Tissue-specific expansion of NKT and CD5+B cells at the onset of autoimmune disease in (NZBxNZW)F1 mice.

Natural killer T (NKT) cells and CD5(+)B cells were searched for in various immune organs of autoimmune prone (NZBxNZW)F(1) (NZB/W F(1)) mice. The number of lymphocytes increased in the liver, spleen, and peritoneal cavity after the onset of disease (at the age of 30 weeks) while the number of thymocytes decreased at that time. Prominent changes of lymphocyte subsets were seen in the liver and peritoneal cavity, namely, expansion of IL-2Rbeta(+)TCRalpha beta(int) cells in the liver and of CD5(+)B220(+) cells in the peritoneal cavity. The majority of TCRalpha beta(int) cells in the liver were NK1.1(+), and CD5(+)B cells in the peritoneal cavity were CD1d(+). Proteinuria became prominent in NZB/W F(1) mice with the progression of disease. In parallel with this progression, the proportion of NKT cells decreased slightly in the liver, but their absolute number remained at a high level in this organ. These NKT cells were CD4(+) and used an invariant chain of Valpha14Jalpha281 for TCRalpha. Reflecting the elevation of CD5(+)B cells, autoantibodies against hepatocyte cytoplasmand denatured DNA were detected in sera. Although NKT cells are known to be immunoregulatory cells in some autoimmune mice, the present results raise the possibility that NKT cells as well as CD5(+)B cells might be associated with the onset of autoimmune diseases in NZB/W F(1) mice. Indeed, NKT cells in F(1) mice had a high potential to induce autoimmune-like inflammationwhen alpha-galactosylceramide was administered or when active NKT cells were transferred into young F(1) mice.

Adoptive Transfer↗

PubMed1993

[Reconstructive surgery of knee para-articular amputation stumps].

Reconstructive plastic procedures in primary care and in postprimary/secondary treatment following below knee and above knee amputation are discussed. Short amputation stumps and stumps suffering from insufficient soft tissue coverage should be primarily avoided employing salvage replantation techniques. Secondarily conventional flaps and grafts, tissue expansion and/or microsurgical free tissue transfer all serve for achieving stable skin conditions and preserve adequate stump lengths. Interdisciplinary treatment racionale will lead to improvement of functional and social rehabilitation.

Adolescent↗

PubMed1986

Surgical management of vascular malformations of the head and neck.

The evaluation and treatment of non-involuting hemangiomas with arteriovenous components and arteriovenous malformations of the head and neck remain difficult. Surgical excision is still the most important and effective method of controlling these lesions. Radiotherapy should never be used. It is ineffective, dangerous, and often complicates any later operation that may be required. Evaluation of vascular malformations with computerized tomography, arteriography, magnetic nuclear imaging, and Doppler mapping will aid diagnosis. Adjunctive hypotensive anesthesia, intraoperative embolization with Gelfoam, and temporary peripheral suture ligations have made the surgical task more manageable. The integration of reconstructive techniques into the surgical program is essential if optimum results are to be obtained. Incisions must be planned so that future flap patterns are preserved. Axial vessels may be needed later. Fascial slings, muscle transfers, nerve grafts, and tissue expansion of adjacent normal tissue may be needed to maintain and restore function and features. Above all, the treatment of each patient requires individual planning. The most common errors in the treatment of vascular hemangiomas result from missed diagnoses and faint-heartedness in tackling the surgical removal of such highly vascular tumors. Many patients go for years without finding a surgeon who will help them. We believe that aggressive surgical treatment offers much to many of these patients.

Adolescent↗

PubMed2004

Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients.

Chest wall irradiation is becoming increasingly common for mastectomy patients who have opted for immediate breast reconstruction with tissue expanders and implants. The optimal approach for such patients has not yet been defined. This study assesses the outcomes of a reconstruction protocol for patients who require irradiation after tissue expander/implant reconstruction. The charts of all patients who underwent immediate tissue expander/implant reconstruction at Memorial Sloan-Kettering Cancer Center between January of 1995 and June of 2001 and who had not previously undergone irradiation were retrospectively reviewed. A subgroup of patients who required chest wall irradiation after mastectomy and reconstruction was identified. Those patients were treated according to the following treatment algorithm: (1) reconstruction with tissue expander placement at the time of mastectomy , (2) tissue expansion during postoperative chemotherapy, (3) exchange of the tissue expander for a permanent implant approximately 4 weeks after the completion of chemotherapy, and (4) chest wall irradiation beginning 4 weeks after the exchange. All irradiated patients with at least 1 year of follow-up monitoring after the completion of radiotherapy were evaluated with respect to aesthetic outcomes, capsular contracture, and patient satisfaction. A control group of nonirradiated patients was randomly selected from the cohort of patients treated during the study period. During the 5-year study period, a total of 687 patients underwent immediate reconstruction with tissue expanders. Eighty-one patients underwent postoperative irradiation after placement of the final implant. A total of 68 patients who received postoperative chest wall irradiation underwent at least 1 year of follow-up monitoring after the completion of radiotherapy, with a mean follow-up period of 34 months. Seventy-five nonirradiated patients were evaluated as a control group. Overall, 68 percent of the irradiated patients developed capsular contracture, compared with 40 percent in the nonirradiated group (p = 0.025). Eighty percent of the irradiated patients demonstrated acceptable (good to excellent) aesthetic results, compared with 88 percent in the nonirradiated group (p = not significant). Sixty-seven percent of the irradiated patients were satisfied with their reconstructions, compared with 88 percent of the nonirradiated patients (p = 0.004). Seventy-two percent of the irradiated patients stated that they would choose the same form of reconstruction again, compared with 85 percent of the nonirradiated patients. The results of this study suggest that tissue expander/implant reconstruction is an acceptable surgical option even when followed by postoperative radiotherapy and should be considered in the reconstruction algorithm for all patients, particularly those who may not be candidates for autogenous reconstruction.

Breast Implantation↗

PubMed1988

Infantile myofibromatosis: a review of clinicopathology with perspectives on new treatment choices.

The fibromatoses are a heterogeneous group of disorders characterized by proliferation of fibroblasts. Infantile myofibromatosis is a variant that is distinctive because of its multicentric origin, appearance at birth, and cellular composition, which is predominantly myofibroblasts. We treated a patient with infantile myofibromatosis with the interesting clinical presentation of a linear lesion involving the left arm and shoulder, and aggressive hepatomegaly with jaundice secondary to fibroblastic infiltration of the common bile duct and gallbladder. Diagnosis was confirmed histologically and ultrastructurally. Excision of the cutaneous lesion was facilitated by tissue expansion of uninvolved regional tissue.

Female↗

PubMedDate not supplied

Differential modulation of integrin expression in chondrocytes during expansion for tissue engineering.

Cartilage tissue engineering has an important role to play in the generation of graft material for reconstructive surgery. In cultured chondrocytes, the dedifferentiation of cells seems unavoidable for multiplication. Dedifferentiated cells produce matrix of less quality. Normal cartilage is composed of chondrocytes, which are embedded within an extracellular matrix (ECM). The ECM plays a key role in controlling cellular characteristics and contains the integrins as a large family of heterodimeric cell adhesion receptors involved in cell-cell and cell-matrix interactions. In this study, the characteristic changes of integrin expression and expression of matrix proteins during the course of dedifferentiation of chondrocytes in cell culture for 1, 6 and 21 days, analyzed at the mRNA level by microarray analysis and at the protein level by immunohistochemistry, are described. The components of the fibronectin receptor, integrin beta1,alpha5, in conjunction with the ligand fibronectin, were up-regulated during dedifferentiation. Integrin beta3 was expressed in the grey area. The components of the vitronectin-receptor, integrin alpha2b, alpha v, as well as integrin beta5, were activated on day 21, but neither vitronectin nor osteopontin were expressed by the cells. With ongoing dedifferentiation, activation of the GPIIb/GPIIIa receptor was found. The integrins beta2, beta4, beta6, beta8 and alpha2, alpha4, alpha6, alpha7 and alpha11 were never expressed. ILK, CD47 and ICAP1, as components of the intracellular signalling cascade of several integrins, were activated with ongoing dedifferentiation. In conclusion, a candidate for signal transmission during dedifferentiation is the fibronectin receptor (integrin alpha5beta1) in conjunction with its ligand fibronectin. Other receptors, e.g. for vitronectin and osteopontin (alphaVbeta3) or laminin (alpha6beta1) or their ligands, do not seem to be involved in signal transmission for dedifferentiation. In addition, the GPIIb/IIIa-receptor seems to assist the process of dedifferentiation. Intracellularly, ILK, ICAP1 and CD47 might assist the transduction of the integrin-dependent signals.

Cell Culture Techniques↗

PubMed1991

Controlled expansion of peripheral nerves: comparison of nerve grafting and nerve expansion/repair for canine sciatic nerve defects.

The inherent disadvantages of nerve grafting have made it necessary to find alternative techniques for treating segmental nerve loss. This study compares the techniques of nerve grafting and nerve expansion/repair for the management of nerve injuries with segmental nerve loss in an animal model. Bilateral segmental sciatic nerve defects were created in eight dogs. On one side a 2-cm segment was excised and replaced with a nerve graft; on the other side a 2-cm defect was created with ligatures and the nerve underwent preliminary expansion and then repair. Eighteen months later nerve conduction velocity (NCV), gastrocnemius contraction force (GCF), and muscle weight (GMW) were determined for the seven surviving animals. NCV for the expanded repair was 58.66 +/- 34.18 m/sec and 47.73 +/- 7.93 for the grafted repair (p = 0.4); GCF was 619.04 +/- 353.70 gm for the expanded repair and 726.80 +/- 415.78 gm (p = 0.2) for the grafted repair; and GMW was 82.80 +/- 5.68 gm for the expanded repair and 109.55 +/- 20.63 gm (p = 0.02) for the grafted repair. The data suggest that: 1) conventional tissue expansion techniques can be used successfully to repair segmental peripheral nerve defects; 2) NCV and GCF are comparable for grafting and expansion/repair techniques although GMW is significantly higher in the grafted group; and 3) nerve expansion/repair may prove to be a useful alternative to grafting.

Action Potentials↗