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Results for “Tissue Expansion”

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PubMed1998

Presurgical columellar elongation and primary retrograde nasal reconstruction in one-stage bilateral cleft lip and nose repair.

We present a new combined approach to primary bilateral cleft lip, nose, and alveolus repair using presurgical nasoalveolar molding combined with a one-stage lip, nose, and alveolus repair. Presurgical alveolar molding is used to bring the protruding premaxilla back into proper alignment with the lateral segments in the maxillary arch. Presurgical nasal molding produces tissue expansion of the short columella and nasal lining. A coordinated surgical approach involves a one-stage repair of the lip, nose, and alveolus. The nasal repair uses a retrograde approach in which the prolabial flap and columella are reflected over the nasal dorsum by continuing the dissection behind the prolabium up the membranous septum and over the septal angle. Tissues are dissected out from between the tip cartilages, and the domes are sutured together in the midline. This method joins a new class of bilateral cleft repairs that place the primary emphasis on correction of the deformity of the nasal tip cartilages.

Alveolar Process↗

PubMed1993

Prefabricated flaps using tissue expanders: an experimental study in rats.

The aim of this study was to determine if muscle vascularized pedicle flaps (MVP flaps) elevated in expanded tissue on the rat would survive to the same or greater area than flaps elevated in nonexpanded tissue. The animals were divided into three groups: group I (n = 10), with a tissue expander; group II (n = 10), with a tissue expander but not expanded; and group III (n = 10), with a thin silicone sheet (Biobrane). The mean surviving area of group I (96.6 +/- 3.6 percent) was statistically higher than that of group II (73.2 +/- 24.7 percent) (p < 0.05) and group III (59.5 +/- 25.1 percent) (p < 0.005). These experiments demonstrate that there is a larger area of flap survival in expanded muscle vascularized pedicle flaps than that found in nonexpanded flaps in rats. The mechanism of increased vascularity associated with tissue expansion is still unclear, but microangiography of flaps showed increased vascularity of the pedicle itself, especially in group I.

Angiography↗

PubMed1994

Wound closure using a skin stretching device.

The recent development of an indexed tissue advancement system makes it possible to take advantage of the viscoelastic properties of skin to close large wound deficits in one procedure. A case is presented in which serial excision of a previous split-thickness skin graft and tissue expansion to achieve wound coverage were performed in one sitting to close an 8cm defect on the lateral side of the patient's leg without subsequent wound separation or dehiscence.

Child↗

PubMed1996

Use of tissue expanders for wound closure of spinal infections or dehiscence.

Posterior spinal incisions that are made through skin and have been compromised by radiation or prior incisions can be difficult to obtain stable closure. In addition, if a wound has developed a postoperative infection or wound dehiscence caused by poor wound healing, severe complications can develop. The technique of expanding adjacent normal skin with implantable tissue expanders has been used in select cases with success. The techniques and indications for tissue expansion in posterior lumbar wounds is reviewed and several case reports presented.

Adult↗

PubMed1993

The role of the contractile fibroblast in the capsules around tissue expanders and implants.

The occurrence, structure and contractility of myofibroblasts in the capsules around tissue expanders and static implants has been studied in the rat, pig and humans. The capsules showed a characteristic layered structure with myofibroblasts being the predominant cell type. Capsular strips contract in vitro in a manner characteristic of fibroblast contraction. The contractile ability decreased with the time since expander insertion; and increased with expander exposure, peri-expander infection and clinical evidence of adverse capsular contracture. An hypothesis is proposed that capsular contracture is analogous to wound contraction, and that intraimplant pressure usually inhibits capsular contraction. Evidence is shown from intraexpander pressure measurements to support this hypothesis. The clinical implications for tissue expansion and breast augmentation are discussed.

Animals↗

PubMed2001

Results of immediate breast reconstruction after skin-sparing mastectomy.

Skin sparing mastectomy (SSM) removes the breast, nipple-areolar complex, previous biopsy incisions, and skin overlying superficial tumors. Preservation of the native skin envelope facilitates immediate breast reconstruction. The procedure has been adopted for the treatment of breast cancer. All cases of SSM and immediate breast reconstruction performed by the senior author (G.W.C.) from January 1, 1993, through December 12, 1997, were reviewed. Patient demographics, cancer staging, treatment, types of surgery performed, and postoperative outcomes were examined. Aesthetic outcomes were measured using four 3-point subscales. A total of 100 patients underwent 118 SSMs during the study period. The American Joint Committee on Cancer staging was as follows: stage 0, 27 patients; stage I, 25 patients; stage II, 39 patients; stage III, 7 patients; stage IV, 3 patients; recurrent, 2 patients; and cystosarcoma phylloides, 1 patient. The mean follow-up was 42.7 months. Local recurrence occurred in 2 patients (2.7%). Reconstructive methods included the transverse rectus abdominis musculocutaneous flap (N = 82; pedicled, 73; free, 9), the latissimus flap (N = 18), and tissue expansion (N = 20). Two patients underwent contralateral delayed reconstruction. The aesthetic results achievable with the three methods were similar. The failure rate was higher for expander reconstruction (10%) than those observed for transverse rectus abdominis musculocutaneous (4.9%) and latissimus (5.6%) flaps. SSM can be used in the treatment of invasive breast cancer without compromising local control. The aesthetic results of the three methods were similar, but tissue expander reconstruction had a higher failure rate.

Adult↗

PubMedDate not supplied

Prevention and treatment of postburn scars and contracture.

The management of postburn reconstruction is complicated by the frequent occurrence of multiple reconstructive needs in a single patient. This article presents a simple, comprehensive approach to burn scar reconstruction. The primary aim of the surgeon is to prevent burn scar deformity by rapid wound closure, correction of tissue deficiencies, and assiduous attention to postoperative splinting and compression therapy. The initial step in managing secondary deformities is to prioritize reconstructive needs. Reconstruction is then carried out in a stepwise fashion aiming to restore active function first, followed by passive function, and finally addressing aesthetic reconstruction. Reconstructive techniques are applied in a hierarchy from simplest to most complex. Primary excision and closure of scars by reorientating the scar to the lines of relaxed skin tension can significantly improve appearance. The use of z-plasty, flap repair, and tissue expansion are also reviewed. Skin expansion, in particular, has become the standard management of postburn alopecia and, although associated with a relatively high rate of complication, has significantly improved the aesthetic appearance of such patients. The management of common problems affecting the face is discussed with particular reference to management of the eyelids, oral commissure, and lips. These areas need to be reconstructed as aesthetic units and each requires individualized management of donor tissue. The reconstruction of the burn patient is often a long process requiring multiple procedures. The approach presented here advocates a stepwise, prioritized approach aiming at both maximum function as well as optimal appearance.

Burns↗

PubMed1996

Repair of "coup de sabre," a linear form of scleroderma.

A case of coup de sabre, a linear form of scleroderma, is presented. Treatment consisted of soft-tissue expansion and autologous bone grafting to the forehead, a composite graft for alar reconstruction, and a scalp graft for eyebrow reconstruction. None of the linear scleroderma cases reported in the literature consisted of bony reconstruction.

Adult↗

PubMed1990

The preexpanded radial free flap.

The experimental basis for free-flap preexpansion is briefly discussed. Two cases are reported in which the ankle/heel area was resurfaced and reinnervated with a preexpanded radial flap. The size of the first flap was half the surface area of the entire forearm. Direct closure of the secondary defect was possible with a single scar and without functional deficit in both cases. The flaps were well-vascularized and consisted of the sensory distribution of one peripheral nerve division, which was anastomosed in the recipient site. This preparation proved to be finer and to have better contouring capacity and skin quality than existing alternatives. It is clear that hydraulic tissue expansion facilitates great additional use of the radial flap as well as a range of other modified free flaps when there is time available for the flap to be developed prior to transfer.

Adolescent↗

PubMed1992

Experience with novel uses of tissue expanders in burn reconstruction of the face and neck.

Total or subtotal resurfacing of the face with suitable, well-matched skin from the upper trunk and neck is usually difficult because of the dearth of unscarred donor site. Tissue expanders have been used primarily to construct local advancement flaps of tissue immediately adjacent to a tissue defect or deformity. These flaps often lack adequate mobility to allow coverage of large areas. In this report, I describe a clinical experience of 11 patients followed for 27 to 75 months in whom tissue expanders were used to develop large, full-thickness skin grafts or transposition flaps for total or subtotal resurfacing of the face and neck. Large, full-thickness skin grafts were developed from relatively small donor sites using tissue expanders. They behaved identically to unexpanded full-thickness skin grafts. They were found not to shrink with storage. The donor sites were closed primarily, obviating the need to graft the donor site. The tissue expander-enhanced transposition flaps appeared to have enhanced vascularity and provided ample, suitable tissue for reconstruction of the face and neck. Tissue expansion resulted in very mobile, thin, hearty flaps that provided excellently matched skin cover for the face and neck. Complications, some of which are unique to these techniques, and indications for the techniques are reviewed.

Adult↗

PubMed1996

Autogenous soft-tissue procedures and osseointegrated alloplastic reconstruction: their role in the treatment of complex craniofacial defects.

Between 1990 and 1994, twenty-seven patients with extraoral craniofacial defects were treated at the Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit in Edmonton. Fourteen patients required management by a combination of alloplastic and autogenous techniques to optimize their reconstructive result. Autogenous soft-tissue procedures were performed almost twice as often in patients whose deformity was the result of trauma. Autogenous soft-tissue procedures included soft-tissue expansion, static facial slings, free and pedicled vascularized bone grafts, eyebrow reconstruction, brow lifts, and scar revisions. These reconstructive procedures are illustrated in three cases.

Adult↗

PubMed2003

Microtia reconstruction: an update.

Reconstruction of the microtic ear remains one of the most challenging procedures encountered by the reconstructive surgeon. The use of autogenous rib cartilage continues to be the gold standard for microtia repair. Numerous refinements and modifications in the original technique described by Tanzer have paved the way for exceptional results in experienced hands. However, ideal results are not always achieved, and there continue to be drawbacks with the standard approach to reconstruction with autogenous rib cartilage. In an attempt to circumvent these shortcomings, surgeons have developed alternative or adjuvant techniques to repair the microtic ear, including the use of tissue expansion, alloplastic implants, and osseointegrated prostheses. Finally, greater emphasis is being placed on early atresia repair in appropriate candidates.

Age Factors↗

PubMedDate not supplied

Use of a soft tissue expander before surgical treatment of clubfoot in children and adolescents.

Primary closure of the skin after surgical correction of severe clubfoot is difficult, sometimes impossible. The authors describe a surgical technique with the use of a soft tissue expander prior to surgical treatment on clubfoot in children and adolescents. They operated on 13 feet (10 patients) with rigid clubfoot, with ages ranging from 3 to 16 years (average 10 years). Satisfactory skin healing with primary closure of the skin was obtained in 10 feet; the remaining 3 had complications such as infection, skin necrosis, and premature exposure of the expander. The authors conclude that soft tissue expansion before surgical correction of clubfoot in selected cases is a good alternative for the management of skin closure. Special attention should be given to surgical technique.

Adolescent↗

PubMed1995

Expanded pectoralis major myocutaneous flaps in head and neck surgery.

The use of tissue expanders in head and neck surgery has been popularized since the early 1980s. Tissue expanders are currently used in nasal reconstruction, alopecia, and other head and neck defects when there is inadequate tissue or when transposition of a local flap would create a significant donor-site deformity. Occasionally, situations in head and neck reconstruction arise where local, regional, or free flaps are not available or sufficient for head and neck reconstruction. In these situations, the use of controlled tissue expansion can be employed for enlarging myocutaneous flaps for head and neck reconstructive surgery. Two cases illustrated here present the principles and techniques of this means of reconstruction.

Aged↗

PubMed2001

Infusion port dislodgement of bilateral breast tissue expanders after MRI.

Tissue expanders are placed routinely for breast reconstruction, and magnetic resonance imaging (MRI) is a common diagnostic procedure. Many studies have reported on the safety of MRI in patients with nonferromagnetic implants; however, many tissue expanders contain ferromagnetic components. The authors present a case of bilateral tissue expander infusion port dislodgment after MRI. A 56-year-old woman underwent bilateral mastectomy and immediate reconstruction with McGhan BIOSPAN tissue expanders. These implants contain integral nonferromagnetic infusion ports, as well as small, powerful Magna-Site magnets. Several weeks postoperatively the patient underwent MRI of her spine, which was ordered by her primary physician for back pain. Subsequently, the infusion ports could not be located with the finder magnet. A chest radiograph was obtained, which demonstrated bilateral dislodgment of the infusion ports. Surgical removal and replacement of the tissue expanders were required. Safety considerations of MRI have been discussed extensively in the literature, and data on MRI with various implanted devices have been obtained. The potential risks of performing MRI on patients with metallic implants include conduction of electrical currents, heating of the implant, misinterpretation resulting from artifact, and the possibility of movement or dislodgment of the implant. The small magnet integral to many tissue expanders may be overlooked by patients and physicians during pre-MRI screening. All patients undergoing tissue expansion with implants that contain integral ports should be thoroughly warned about the potential hazards of MRI.

Breast Neoplasms↗

PubMed1997

[Effect of irradiation fields on the results of breast reconstruction with skin expansion after radiotherapy].

Deferred prosthetic breast reconstruction after skin expansion is considered to be difficult after radiotherapy. The authors report a series of 14 cases of reconstruction after radiotherapy, compared with 6 cases of reconstruction without radiotherapy. They reported a similar quality of results after radiotherapy not including irradiation of the chest wall and in the absence of radiotherapy (p = 0.742). On the other hand, a significant deterioration of the results was observed when radiotherapy included chest wall irradiation (p = 0.0015). Finally, no direct correlation was observed between the macroscopic appearance of the skin and presence or absence of a history of irradiation of the chest wall. They conclude that the indications for reconstruction by tissue expansion after radiotherapy must be based more on the irradiation protocol than on the macroscopic appearance of the skin.

Adult↗

PubMed2002

Expanded latissimus dorsi free flap for the treatment of extensive post-burn neck contracture.

An expanded latissimus dorsi flap (expanded LD flap) was transferred in two patients with severe post-burn neck contracture. Free flaps created using standard techniques are of limited size and sometimes cannot cover the defect after excision of scar tissue, particularly when a severe burn scar extends to the facial region. However, the authors found in their cases that the expanded LD flap could cover the whole anterior neck and face. The flap was sufficiently reduced in thickness so that revisional operations required for debulking were limited to the area around the pedicles. It is suggested that tissue expansion prior to free flap transfer is useful for enlargement of the flap survival area and thinning of the flap.

Adult↗

PubMed1999

Secondary expansion of a replanted scalp salvaged by an intrinsic arteriovenous shunt.

1. Although scalping injuries reported in most large series rarely involve young children, partial scalp replantation, even in a 2-year-old boy after a dog-bite avulsion, should also be warranted. However, technical difficulties because of the diminutive vasculature can be expected. 2. Unconventional methods for reestablishing inflow or outflow for the replanted scalp may become the only practical alternative and must not be overlooked. In this case, an arteriovenous shunt between the frontal branch of the superficial temporal artery within the amputated part itself to a more distal scalp vein at the superior edge of the fragment allowed high-output flow to maintain patency after recurrent thromboses of the conventional superficial temporal arterial anastomosis. This fistula was assumed to be the major contributor to nutrient flow of the remaining scalp, as the parietal branch was truncated along the margin of the avulsion. 3. Delayed tissue expansion is also an option. In this case, delayed expansion of the replanted scalp that survived allowed elimination of the skin grafts needed to cover areas where necrosis ensued, restoration of the anterior hairline, and resulted in a more normal appearance.

Animals↗