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Results for “Tissue Expansion”

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PubMed2002

[Effect of local application of basic fibroblast growth factor and sucralfate on skin tissue structure after expansion].

OBJECTIVE: To investigate the effect of local application of basic fibroblast growth factor (bFGF) and sucralfate on the skin tissue structure after expansion. METHODS: Continuous tissue expansion (CTE) experimental animal model was made with constant pressure pump in nine white pigs. The bFGF and sucralfate were perfused between tissue and tissue expander. Both bFGF and sucralfate were injected in group I, both bFGF and normal saline in group II, only sucralfate in group III, and normal saline in group IV as control group. The samples were took from each pig for histomorphological assessment on the 3rd day and 6th week after expansion. RESULTS: Compared with control group, epidermal, granular spinous and basal cell thickness increased significantly (P < 0.05) in group I; in dermal layer, dermal thickened slightly and the collagen fibers became thicker and orderly; the elastic fiber regenerated significantly; the density of fibroblasts and capillaries significantly increased (P < 0.05) in group I. The collagen fibers were broken on the 3rd day and 6th week after expansion in control group. However, the thickness of the fibrous capsule layer was similar in each group. CONCLUSION: Local application of exogenous bFGF and sucralfate combined with CTE can greatly promote the skin growth. It can accelerate the tissue expansion.

Animals↗

PubMed2000

Effect of radiation on skin expansion and skin flap viability in pigs.

The aim of the present study was to investigate the effect of radiation treatment both on skin tissue expansion with the chronic inflation of subcutaneous expanders and on skin flap viability in surgically delayed and expanded skin in the pig. One flank in each of six pigs (initially weighing 17 +/- 1.8 kg) was randomly assigned for radiation treatment, and the contralateral flank served as a nonirradiated control. Three mirror-image, 8 x 10 cm, rectangular templates were marked on each flank; these templates were randomly assigned to the construction of a delayed skin flap (group A), a skin flap raised on expanded skin (group B), or a skin flap raised on expanded skin with a capsulectomy before flap surgery (group C). Radiation treatment was performed using sequential radiation with three fractions per week (810 cGy/fraction) for 2 weeks, with a total dose of 4,860 cGy. Twelve weeks after radiation treatment, skin expanders (8 x 10 cm) were installed subcutaneously in the locations assigned for skin expansion. Skin expansion by the inflation of subcutaneous skin expanders with saline twice weekly was started 8 weeks later and lasted for 3 weeks. Two weeks after surgical delay and the last skin expansion, 8 x 20 cm skin flaps were raised on the locations assigned for delayed skin flaps, expanded skin flaps, and expanded skin flaps with a capsulectomy. Skin flap viability was assessed 24 hours later using a fluorescein dye-staining technique. Skin expansion by the inflation of subcutaneous expanders with saline was slower (p < 0.05) in the radiated skin (39 +/- 6 ml/filling) than in the nonirradiated control skin (51 +/- 6 ml/filling). Radiation reduced the overall area of expanded skin by 23 percent (p < 0.05) compared with the control. Radiation treatment also reduced skin viability by 36 percent (p < 0.05) in the delayed skin flaps, 27 percent (p = 0.10) in the expanded skin flaps, and 36 percent (p < 0.05) in the expanded skin flaps with a capsulectomy when compared with their contralateral, nonirradiated controls. There were no significant differences in skin viability among these three types of skin flaps within the radiated and nonirradiated groups. Taken together, these observations indicate that radiation treatment reduced the effectiveness of the surgical delay procedure, the amount of subcutaneous skin expansion (by an increase in skin area), and skin flap viability. However, a capsulectomy alone did not affect the viability of skin flaps raised on expanded skin.

Animals↗

PubMed1996

[Clinical application of 72-hour fast expansion of the soft tissue].

The rapid expansion of the soft tissue has been applied in plastic surgery. To further shorten the expansion period, we undertook a clinical study on 72-hour fast expansion and applied this technique to 11 patients with different defects on their face, neck, shoulder or elbow after resection of scar, melanoma, angioma or due to trauma. Satisfactory results have gained. This paper not only introduces the clinical application of the technique, but also discusses the theoretical basis, advantages and key points of the operation.

Adolescent↗

PubMed1987

Calvarial erosion after scalp expansion.

A case is described of tissue expansion of the scalp with resultant erosion of the outer table and diploe of the calvaria. This resorption may have resulted from a prolonged period of expansion, excessive tension from inflation, and/or the nature or location of the defect. In cases of scalp expansion where the loose areolar space has become obliterated, periodic limited computed tomographic scanning may be useful to monitor the integrity of the skull. Postexpansion protective headgear may be indicated in selected patients.

Alopecia↗

PubMed1995

[Full-load expansion techniques and preliminary clinical application].

For accelerating the inflation process of soft tissue expansion, a continuous inflation protocol regarding pain as the criterion of over-inflation, the full-load expansion technique, was introduced. It is carried out by restricting persistently the pressure in the expander near the pain threshold in a state of dynamic equilibrium between the infusing rate and the skin expansion velocity, with a simple and practical assembled device. This inflation is neither at a uniform infusing rate nor at a constant filing pressure. 19 expanders in 13 patients were inflated following this protocol. Their inflations were respectively fulfilled in 5 to 20 days, depending individually on their anatomic regions, total volumes of infusion, areas of the overlying skin and the patient susceptibilities.

Alopecia↗

PubMedDate not supplied

Facial reconstruction after mucormycosis in an immunocompetent host.

Cutaneous mucormycosis in the immunocompetent patient is exceedingly rare. However, if the infection is not rapidly identified and aggressively treated, its progression is fast, fulminate, and characteristically fatal. This case report describes the treatment and surgical reconstruction of a previously healthy, immunocompetent girl after pervasive mucormycosis of the right face. The patient's diagnosis was established by tissue biopsy. She was promptly started on 1.5 mg/kg per day intravenous amphotericin B and underwent numerous surgical debridements resulting in a large defect of the right face. After 2 xenograft procedures the defect was covered with an autologous split thickness skin graft. During this procedure a submandibular 4 x 7-cm tissue expander with a remote occipital port was placed superficial to the platysma. Serial tissue expansion took place over 8 weeks without complication. The tissue expander was removed and the expanded flap was advanced over the freshly de-epithelialized defect. Revisional surgeries may yet be performed; notwithstanding, the patient and her parents are pleased with the current results. Although the management of cutaneous mucormycosis often involves disfiguring tissue resection, the current wealth of reconstructive modalities can greatly improve the aesthetic and functional outcomes of requisite therapy.

Amphotericin B↗

PubMed2002

The management of the postoperative disrupted abdominal wall.

BACKGROUND: Dehisced abdominal wounds are common. Their management is generally difficult and often prolonged, with incisional hernias a common occurrence. A new technique is presented that results in accelerated delayed primary healing with full thickness skin and subcutaneous tissue coverage. METHODS: The technique involves a combination of vigorous wound toilette, the judicious use of sutures and tissue expansion produced by the application of specially designed external tissue expanders. Gradual approximation of the wound edges is achieved and final suture allows closure by full thickness skin and subcutaneous tissue. RESULTS: Sixteen patients, 10 with one or more intestinal fistula, developed abdominal wall dehiscences. At discharge all wounds were closed, from 2 days in wounds averaging 12 x 5 cm to 18 days in a 29 x 24 cm wound. The follow-up, both in numbers and length, was limited for various reasons. CONCLUSIONS: The technique appears to be generally successful. The simplicity allows easy learning and may avoid a major operative procedure. Accelerated delayed primary closure by full thickness skin and subcutaneous tissue has considerable economic benefits for the patient and the health service.

Adult↗

PubMed2004

Use of self-expanding, hydrophilic osmotic expanders (hydrogel) in the reconstruction of congenital clinical anophthalmos.

PURPOSE OF REVIEW: Rehabilitation of the congenitally anophthalmic orbit is frustrating to both the parents and physician. Traditional methods involve using progressively enlarging static acrylic conformers to expand the conjunctival socket, followed by placement of conventional static spherical orbital implants, dermis-fat grafts, or inflatable balloon expanders for orbital enlargement. Limitations of these methods typically result in less-than-optimal cosmetic outcomes, with retardation of bony orbital and overlying soft tissue growth adversely affecting midfacial growth and symmetry. Recent advances in tissue expansion technology may offer additional, novel alternatives to conventional therapies. RECENT FINDINGS: Hydrogel tissue expanders were recently adapted for use in congenital anophthalmia. The expanders are placed in their dry, contracted states, and expand gradually to their full size via osmosis of surrounding tissue fluid, with up to a 10-fold increase in volume. Offering the benefit of predictable and controllable self-expansion, hydrogel expanders may offer yet another alternative or adjunctive therapy to the early rehabilitation of the contracted socket. Separate appliances are used for conjunctival and orbital reconstruction. Initial results appear promising. Tempering the enthusiasm for their use, however-particularly in terms of implanted orbital expanders-is the recent spate of long-term complications reported from previous uses of hydrogels as scleral buckling material. SUMMARY: Self-expanding hydrogel tissue expanders appear to offer an intriguing reconstructive alternative to the frustrating condition of congenital anophthalmia. Long-term safety of the material as an orbital implant has not yet been demonstrated, but early results are promising.

Anophthalmos↗

PubMed1991

[The indications, technics and results of the use of tissue expanders in pediatric surgery].

We review our experience in tissue expansion in twenty-four pediatric patients. The most frequent indications for the use of tissue expanders included congenital nevi and burn scars, they were also used with success in alopecia, congenital abdominal wall defects, mammary hypoplasia and microtia. Tissue expanders were always placed subcutaneously. Both, surgery and body deformity during expansion, were well tolerated. We found complications in five cases, but only in one patient treatment was interrupted. Results were considered excellent in nineteen cases.

Adolescent↗

PubMed2002

Intraoperative expansion of skin around large congenital naevi with foley catheter balloons: 11 new cases.

Tissue expansion allows reconstruction of large cutaneous defects with adjacent skin, similar in appearance and type, without using skin grafts or multiple, regional, distant, or microsurgical flaps. Conventional expansion produces a greater increase in surface and length than intraoperative expansion, but it has several disadvantages and should be reserved for closing problematic defects. There is considerable controversy about the relative effects of intraoperative expansion and undermining on the tensions of closing wounds, although immediate expansion is commonly used particularly in head and neck reconstruction. New multiple external devices have recently been described to expand skin externally, but there are few options as internal expanders. We have chosen multiple Foley catheter balloons, because of their availability and low cost, to repair 11 limb defects after excision of large naevi. The wounds are easy to close, primarily, and postoperative results are good. Dark pigmentation scars are the most common possible complications.

Adolescent↗

PubMed1990

Immediate placement of tissue expanders in the management of large excisional defects on the face.

Where excision of a facial lesion leaves a defect too large for local flap reconstruction, tissue expansion is frequently a more desirable option than a skin graft, providing as it does tissue which exactly matches that which has been lost. For malignant skin lesions where removal should not be delayed by preliminary expansion of the flap, the expander can be placed simultaneously with tumour excision thus keeping the reconstruction to two stages. A temporary skin graft is employed in the interim. Our experience with this approach in five patients with large facial malignancies is presented and discussed.

Aged↗

PubMed1998

Expansion of venous flaps: an experimental study in rats.

In this study, the effects of controlled tissue expansion on the survival of unipedicled venous flaps were investigated in rats. In three groups of Lewis rats, a 3 x 6 cm unipedicled Lateral thoracic venous flap was studied with group 1 as control group (n = 30) without any manipulation, group 2 (n = 30) where an expander was introduced under the flap area but was not expanded and group 3 (n = 30) in which a 40 ml expander was introduced under the flap area and was expanded over a period of 10 days. Observations included gross and histological examination, reverse microangiography, reverse flow resistance and percentage of survival of flaps. Group 3 (expanded) showed more angiogenesis, a better delineation on microangiography, lower reverse flow resistance and higher survival rates as compared to group 2 (non-expanded). In the control group the survival rate of flaps was the poorest and the flaps showed higher rates of reverse flow resistance. Microangiography was not successful in the control group. In a pilot project prior to this experiment microscopic examination of the Lateral thoracic vein in 10 Lewis rats had confirmed the presence of two or three valves in this vein.

Angiography↗

PubMedDate not supplied

Preexpansion of free flap donor sites used in reconstruction after burn injury.

Burn wound management usually can be achieved successfully without reliance on any free tissue transfers. This is true partly because tissue expansion techniques for the creation of local flaps have become increasingly versatile and are a simpler alternative when vascularized tissues are required. However, in special circumstances both concepts can be combined to further enhance reconstruction after burn injury. In addition, pretransfer expansion of free flap donor sites has many advantages over posttransfer expansion because not only is immediate primary donor site closure possible, but fabrication of flaps with desired characteristics of size and thickness can be specifically manipulated simultaneously.

Adolescent↗

PubMedDate not supplied

Fundamentals of expanded tissue.

The relatively recent advent of tissue expansion for medical purposes precludes the availability of extensive knowledge concerning the physiologic and histologic changes that occur during controlled expansion of the skin. This paper reviews the basic science and clinical research that has been conducted to investigate the changes and summarizes the findings. It can be concluded that flaps harvested from skin previously expanded have an improved survival rate compared to similar flaps developed in nonexpanded skin. Increased vascularity to either the skin, the capsule that forms around the expander, or both probably in some way accounts for the improved survival. Controlled expansion of the skin results in the creation of additional new skin at the expense of thinning the dermis and subcutis. This thinning is associated with an overall decrease in tensile strength of the expanded skin. The increase in surface area gained from skin expansion probably varies according to the type of skin expanded and the underlying tissues that serve as a foundation for the expander.

Humans↗

PubMed1992

The suture tension adjustment reel. A new device for the management of skin closure.

The initial clinical experience with a new device, called the Suture Tension Adjustment Reel (STAR), is described. The historical precedence and rationale underlying linear tissue expansion is presented. Case reports illustrate the use of the STAR for preoperative tissue stretching, for intraoperative tissue stretching, and for tissue mobilization as applied to scalp reduction surgery. The multipurpose device is a safe, simple, and reliable adjunct to sutured surgery. It is of value in the general management of tensioned and nontensioned skin closures.

Adult↗

PubMed1998

[Breast reconstruction: autologous tissue versus implant].

UNLABELLED: Modified radical mastectomy remains the standard for treatment of breast cancer. Women faced with the diagnosis of breast cancer often find it difficult to cope with the arousing emotions. Fear of death or cancer recurrence and a perceived loss of femininity often coexists with the desire for a return to normality and wholeness. For women seeking breast reconstruction various techniques have been developed. Two different ways for breast reconstruction have become a standard. One way is the reconstruction by tissue expansion or transposing locally available tissue with the use of implants. The other way is the reconstruction of the breast without using any implants with the Latissimus dorsi flap or the TRAM flap. METHODS: We performed 291 breast reconstructions. In 125 women available tissue and an implant was used. The Latissimus dorsi flap was used in 57 cases and 109 TRAM flaps either pedicled or as a microvascular flap were performed. RESULTS: Using expanders we found a perforation of the device in 2 cases. After using implants there were capsular contracture in 2 cases and in 1 case we had an infection. Using autologous tissue we had 2 partial flap necrosis, 4 hematomas, and 4 prolonged healings. There was no complete flap necrosis. DISCUSSION: Breast reconstruction using autologous tissue i.e. the TRAM flap is supposed to be a standard technique. Microsurgical transplantation of the TRAM flap shows almost no morbidity of the donor site area. Autologous tissue follows the changes of the body like weight gain or reduction to a certain extend and shows neither capsular contracture nor other implant associated side effects. Women get the impression that the TRAM flap is like soft tissue to the touch and not like a foreign body. The aesthetic results were in all cases superior sometimes needing minor secondary correction and mostly shaping of the nippel-areola complex. All patients were pleased with the result.

Breast Implantation↗

PubMed1995

Endoscopic surgery of the upper extremity.

Endoscopic techniques for surgery of the upper extremity show great promise based on recent discoveries of anatomic tissue planes. These planes can be dissected using new technology consisting of endoscopic balloons that create optical cavities that permit "incisionless" surgery. This article contains a review of the anatomic principles, new surgical technology, and development of endoscopic tools, as well as an example of endoscopic tissue expansion placement for soft-tissue augmentation in the upper extremity. Endoscopic techniques as they relate to fractures, synovectomy, and peripheral nerve decompression are discussed.

Arm↗

PubMed1998

Why autologous tissue?

Breast reconstruction with autologous tissue achieves more natural results and a better simulation of a real breast than reconstruction based on prosthetic implants. Unlike implant-based reconstructions, which tend to develop capsular contractures, the results of autologous tissue reconstruction tend to improve with time. In the long run, the costs of autologous breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) flaps are equal to or lower than those of reconstruction with tissue expansion and implants. Consequently, autologous tissue is preferable for most patients, provided they are suitable candidates for the surgery required by autologous reconstruction.

Breast Implants↗