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At least 793 records · Page 44Linked to original sources

PubMed2006

Preexpanded distant "super-thin" intercostal perforator flaps for facial reconstruction without the need for microsurgery.

BACKGROUND: Concept of the 'super-thin perforator flap' was introduced in 1994 by authors. Since then, various types of 'super-thin perforator flaps' were applied successfully especially for contour sensitive reconstruction such as face and neck. METHODS: Eleven patients requiring large flaps who presented with extensive disfiguring facial scar (male: seven cases, female: four cases). On the consideration of flaps' colour, texture and thickness requirements, the authors selected 'super-thin' anterior intercostal perforator flaps (AICP, range from 4 x 14 cm to 25 cm x 9 cm) for reconstruction purpose. First, tissue expanders (volume range from 800 cc to 1200 cc) were carefully inserted under the AICP. After the flaps were expanded for 2 months, distant scars were removed and the covering super-thinned flaps were transferred into recipient site. Two weeks later, pedicles in the anterior chest were cut down and flaps were transferred to replace all the left scars. RESULTS: Flap were survived without any complications. The colour, texture and thickness of the transferred flap were satisfactory, shrink of flaps were not observed after long term follow-up. The authors present a method of facial reconstruction that has the advantages of creating a large amount of thin tissue of both good colour and texture, without the need of microsurgery and few disadvantages of donor-site morbidity. The disadvantages are three-staged procedures, complications of tissue expansion and uncomfortable compulsory posture for patients. In our opinion, this is an alternative method of choice for reconstructing all large defects in the lower two-thirds of the face.

Adult↗

PubMed2005

Unilateral postoperative chest wall radiotherapy in bilateral tissue expander/implant reconstruction patients: a prospective outcomes analysis.

BACKGROUND: Implant reconstruction has a major role to play in breast reconstruction, as some patients neither wish nor are suitable for autogenous reconstruction. The suitability of implant reconstruction in patients who may receive postoperative, adjuvant radiation therapy has not, however, been fully clarified. The purpose of this study was to evaluate complications, capsular contracture, aesthetic outcomes, and patient satisfaction in patients who have undergone bilateral tissue expander/implant reconstruction and unilateral, post exchange, adjuvant radiotherapy. In this study population, the effect of radiation can best be appreciated because the nonirradiated breast acts as a control. METHODS: A review of all bilateral tissue expander/implant reconstructions at a single cancer center was undertaken. Twelve patients who underwent bilateral expander/implant reconstruction and unilateral postexchange radiotherapy were eligible for participation. A prospective evaluation of complications, cosmesis, and patient satisfaction was performed. The evaluation of cosmesis and patient satisfaction was executed for 10 of the 12 patients, as two were dead at the time of follow-up. RESULTS: Mean follow-up was 23.5 months (range, 12 to 58.5 years). In 40 percent of patients, there was no discernible difference in capsular contracture between the irradiated and nonirradiated breasts. In 50 percent of patients, the irradiated breast demonstrated increased contracture by a single modified Baker grade. In 10 percent of patients, contracture of the irradiated breast was two modified Baker grades greater than that of the nonirradiated side (grade III versus grade I). CONCLUSION: For the majority of patients, the degree of capsular contracture was higher on the irradiated side, yet overall symmetry, aesthetic results, and patient satisfaction remained high. These data support the conclusion that immediate, bilateral breast reconstruction using tissue expansion and implants is an acceptable option for the subset of patients who may undergo unilateral, postexchange radiotherapy.

Algorithms↗

PubMed1995

Unilateral breast atrophy.

This represents the only known case of acquired unilateral breast atrophy described after previously normal bilateral breast development. Our patient developed left breast atrophy with normal microscopic examination (biopsy) subsequent to infectious mononucleosis. Her reconstruction utilized tissue expansion followed by prosthetic augmentation of the affected side. Despite an exhaustive search, no definitive cause to explain these findings has been found. Perhaps there is some unknown underlying viral etiology that may have further implications for other breast pathology.

Adolescent↗

PubMed2006

The influence of radiotherapy on capsule formation and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants.

BACKGROUND: Capsular contracture occurs more frequently when immediate breast reconstruction (IBR) is associated with radiotherapy (RT) in a post-mastectomy field. The aim of this study was to investigate the impact of RT on surgical outcome after IBR using a single implant type. METHODS: One hundred and thirty-six breast reconstructions were studied in 114 patients: 62 reconstructions were performed using submuscular implants alone and 74 had an implant-assisted latissimus dorsi myocutaneous flap using a McGhan 150 biodimensional permanent expander implant. Data were prospectively collected on capsule contracture, geometric measurements, photographic assessments and pain scores. The median follow-up was 4 (range, 2-5) years. RESULTS: The mean age of the 114 patients studied was 45 (range, 20-77) years. Forty-four reconstructed breasts received RT. Capsule formation was detected in 13/92 (14.1%) reconstructed breasts with no RT and in 17/44 (38.6%) reconstructed breasts with RT. On univariate analysis, RT was the only variable related to capsule formation (p<0.001). Significant differences in geometric measurements of symmetry were identified in patients with capsules compared with those without capsules. Photographic assessments were worse in the capsule group: mean photo score 8 (95% CI 8, 8.5) compared with the no capsule group 6.5 (95% CI 5, 7.5), p<0.001. Persistent pain two years or more after surgery was present in 8/30 patients with capsules and 1/106 with no capsule group, p<0.01. Capsule formation is three times more likely to occur after IBR in association with an RT field. However, as more than 60% of patients do not get capsules despite RT at four years, implant-assisted tissue expansion techniques using a biodimensional device is a viable breast reconstructive option in selected cases.

Adult↗

PubMed2002

[Cancer update on breast reconstruction].

Breast reconstruction is evolving towards immediate reconstruction (IBR). Adjuvant radiotherapy remains an esthetical contraindication to classical techniques due to complication rate (capsular contracture, flap necrosis and contracture). Tissue expansion combined with radiotherapy must be evaluated. IBR quality of life raises the issue of its evaluation. IBR current limits seem to be psychological. The quality of preoperative information will determine IBR real life experience.

Breast Neoplasms↗

PubMed1999

Implantation of a soft-tissue expander before operation for club foot in children.

Primary skin closure after surgery for club foot in children can be difficult especially in revision operations. Between 1990 and 1996 a soft-tissue expander was implanted in 13 feet before such procedures. Two were primary operations and 11 were revisions. A standard technique was used for implantation of the expander. Skin augmentation was successful in 11 cases. There was failure of one expander and one case of wound infection. Sufficient stable skin could be gained at an average of five weeks. Primary skin closure after surgery was achieved in 12 cases. We conclude that soft-tissue expansion can be used successfully before extensive surgery for club foot. The method should be reserved for revision procedures and for older children. The technique is not very demanding, but requires experience to achieve successful results.

Child↗

PubMed1998

Clinical application of expanded free flaps based on primary or secondary vascularization.

Prefabricated free flaps using an expansion technique were used for four reconstructive cases, including two leg reconstructions and two facial reconstructions. In this series, the prefabricated free flaps created by using the expander were classified into two types: the expanded flap based on the conventional vascular pedicle, which is called the expanded flap with primary vascularization; and the expanded flap based on the vascular pedicle in the carrier, which is called the expanded flap with secondary vascularization. The expanded flap with primary vascularization that is created in the trunk has a good indication for leg reconstruction, because it provides an wide and thin flap with minimal donor site morbidity. The expanded flap with secondary vascularization created in the pectoral region has a good indication for facial reconstruction, because it provides good color and texture matches. Although there are some disadvantages in the tissue expansion technique, the prefabricated free flaps using the expander are very effective in facial and leg reconstruction.

Adolescent↗

PubMed2002

Surgical treatment of aplasia cutis congenita of the scalp associated with bilateral coronal synostosis.

Aplasia cutis congenita is a rare condition characterized by the congenital absence of skin. The authors report a case of aplasia cutis congenita of the scalp associated with bilateral coronal synostosis. Simultaneous fronto-orbital advancement and skull reconstruction for large defect at the fontanelle were performed in the initial operation. A tissue expander made it possible to resect most of the hairless scar and totally cover the reconstructed defect and skull. During the second stage, the residual hairless scar was completely covered with hair-bearing scalp by tissue expansion and the residual skull defects were successfully reconstructed with split calvarial bone grafting.

Alopecia↗

PubMed1991

Breast reconstruction after mastectomy. What are today's options?

Breast reconstruction after mastectomy has evolved rapidly in recent years because of public awareness, patient demand, and technical advances. Various methods involving tissue expansion and flap procedures with and without prostheses are currently available. Management of the opposite breast and nipple-areola reconstruction are also options. Patients need to be in good general health to have reconstructive surgery.

Breast↗

PubMed2000

[Viability and dynamic observation of stretchback of the continuously expanded skin flap in the pig model].

OBJECTIVE: To investigate the viability of the continuously expanded skin flap and the dynamic change of flap stretchback in the pig model. METHODS: White piglets and a constant pressure-infusing pump were employed to establish a continuous tissue expansion model. The animals were divided into two groups. The short rectangular expander of 180 ml was used in group A and the long rectangular expander of 210 ml was used in group B. Three days after completion of the continuous expansion, normal random and expanded skin flaps were created to assess flap viability and stretchback. RESULTS: Flap survival length in group A and B increased by 92.60% and 91.96% respectively versus normal random flap. But there was no significant difference in survival length between group A and B. Obvious flap stretchback was observed in the early stage. Eight weeks after flap operation the flap width of group A and B restored to that of the random skin flaps (P > 0.05). CONCLUSION: Continuously fast-expanded skin flaps are reliable in viability for soft tissue reconstruction. Larger expanders cannot further enhance the viability of the expanded flap.

Animals↗

PubMed1991

Technique for correction of areola misplacement with no new scars.

A method of changing the absolute position of the areola if poor positioning occurs after surgery is described. This method uses tissue expansion as an intermediate step and in so doing allows movement with no new scars. There is no reason that medial, lateral, or superior malpositions could not be corrected in this way. Most breast reduction patients with bottoming out will not need this two-stage procedure if the areola is not too high in the beginning.

Adult↗

PubMed2000

[Expanded extra-long fascia flap in the trapezius region for repair of scar contracture of the neck].

OBJECTIVE: In order to gain a larger fascia flap in the trapezius region and to close the donor site easily and primarily. METHODS: We applied tissue expansion to form the expanded extra-long trapezius fascia flap. RESULTS: The flap was used to repair the neck scar contracture with satisfactory effects. CONCLUSIONS: The flap is very useful for patients who have a large burned defect and are short of donor sites, especially the children.

Adolescent↗

PubMed1993

Use of tissue expanders in reconstruction after excision of multiple large silicone granulomas.

We present a case rare for its extensive nature with symptomatic silicone granulomas and for the various extensive reconstructive techniques using tissue expansion in several areas. Although the course of surgical rehabilitation was extensive and prolonged, it was initiated and tenaciously pursued by the woman and her husband who initially requested surgery only for relief of pain in the areas of the buttocks and groin. The eventual results achieved were gratifying to the woman.

Adult↗

PubMed1992

An anatomic review of the delay phenomenon: I. Experimental studies.

A number of experiments were conducted to study the anatomic changes in a flap following a surgical delay using the Doppler probe to add precision to the technique. After scanning the integument of a series of anesthetized animals with the probe, each was sacrificed; a total-body arterial injection was performed with a lead oxide mixture, the integument and deep tissues were radiographed separately, and the results were correlated and compared with our previous human studies. The dog was selected from the range of animals examined, and the arterial networks of a number of skin and muscle flaps were studied with and without a surgical delay. The study included the use of a tissue expander. Results revealed that an adjacent cutaneous perforator could be captured with safety on the artery at the base of an undelayed flap; that the survival length of that flap was related to the distance between perforators; that the necrosis line of the flap usually appeared in the zone of choke vessels connecting adjacent territories; that a surgical delay results in a dilatation of existing vessels with maximal effect in the zone of choke arteries; that the most effective delay was obtained by elevating the flap in stages from the base, leaving detachment of the tip until last; that tissue expansion is a form of surgical delay, with particular emphasis on vessel hypertrophy; and that similar changes occur when a muscle is delayed. The clinical applications of this investigation are presented in Part II of this anatomic review of the delay phenomenon.

Animals↗

PubMed1999

A systematic approach for improvement of the donor sites of fasciocutaneous flaps.

Fasciocutaneous flaps as a group have been maligned more often for fear of potential donor-site morbidity than any concern for reliability. Typically, this is related to limitations imposed by the skin graft necessary to close most such donor sites, as admittedly has been required for the majority (52 percent) of our 313 flaps over the past 2 decades. Nevertheless, 48 percent did not require skin grafts, reflecting the adoption of strategies that evolved to minimize this shortcoming. These included use of fascia-only flaps, primary closure with small composite flaps, direct closure possible by use of rotation or advancement flaps or a second flap, or a delayed closure utilizing either pretransfer or posttransfer tissue expansion. Donor-site complications were actually fewest when a skin graft or primary closure was possible and occurred at the same rate regardless of body region. However, because the skin-grafted donor site was always a cosmetic compromise, a systematic approach to circumvent its use whenever possible is emphasized as a valuable tool to enhance the role of fasciocutaneous flaps as a vascularized flap alternative.

Arthroplasty, Replacement, Knee↗

PubMed2005

Cheek and eyelid reconstruction: the resurrection of the angle rotation flap.

BACKGROUND: Reconstruction of larger cheek and eyelid defects may pose a dilemma for surgeons, since flaps used in reconstruction may be difficult to design, be unreliable, require extensive dissection, and result in neck scarring. Consequently, the authors wish to simplify and expand an overlooked flap, the angle rotation flap, which moves tissue in both a medial and upward direction. METHODS: Twenty patients with cheek and eyelid defects were treated by the angle rotation flap. In this flap design, the angle designed below the ear was closed primarily and the neck tissue previously there was rotated upward and forward to lie in front of the ear. The portion of the flap that was in front of the ear was transposed to the lower lid/cheek area. This flap was modified in several patients by elevation in the deep plane and first-stage tissue expansion. RESULTS: In all cases, good coverage was provided for medial cheek and lower eyelid defects with minimal scarring on the neck. There were no flap losses of any kind. There were no major complications, and all minor incidences were treated by minimal procedures without long-term sequelae. CONCLUSION: The modified angle rotation flap is a useful tool for cheek and eyelid defects.

Arteriovenous Malformations↗

PubMed1995

Esthetic refinements in forehead flap nasal reconstruction.

OBJECTIVE: To identify refinements in forehead flap nasal reconstruction that consistently provide better esthetic and functional results. DESIGN: Case series of patients undergoing forehead flap nasal reconstruction from July 1, 1987, to May 31, 1994. SETTING: University hospital ambulatory surgery department. PATIENTS: Thirty-two patients with various nasal defects. INTERVENTIONS: Modifications of currently accepted techniques of paramedian forehead flap nasal reconstruction, namely, flap harvest and contouring, W-plasty closure of the superior forehead donor site, and creation of soft-tissue triangles. The principles of open-structure rhinoplasty are incorporated into cartilaginous reconstruction of the nasal tip and columella. The alar rim is reconstructed with cartilage grafts placed at the nasal rim. MAIN OUTCOME MEASURES: Esthetic and functional results of nasal reconstruction were subjectively graded by three otolaryngologists (V.C.Q., D.A.S., and M.F.R.) and the patients. RESULTS: Improved esthetic and functional nasal reconstruction. The most common nasal subunits reconstructed were as follows: ala, 27 patients (84%); side-wall, 22 patients (69%); dorsum, 18 patients (56%), and tip, 15 patients (47%). The esthetic results ranged from average to excellent (3 to 5 on a scale of 5), the functional results ranged from improved to much improved over preoperative breathing (4 to 5). Two patients required unplanned surgical revisions. Forty-seven percent of patients chose to undergo dermabrasion. Five patients required postoperative intradermal injection of triamcinolone acetonide (Kenalog). Three patients required preoperative tissue expansion. Flap or graft loss, infection, or hematoma did not occur. CONCLUSIONS: The predictability of the techniques in providing excellent results in patients undergoing nasal reconstruction decreases the need for revision procedures and helps the patient and the surgeon achieve the desired outcome.

Aged↗

PubMed1996

The expanded forehead scalping flap: a new method of total nasal reconstruction.

The challenge of total nasal reconstruction is particularly formidable in the pediatric patient. Forehead skin is taut, and conventional methods of reconstruction, such as the midline forehead flap, provide a paucity of tissue in this age group. Tissue expansion is well-suited modification to overcome this limitation, but as applied to the midline forehead flap, it does not address the resulting vertical forehead scar. We present a new technique for total nasal reconstruction using an expanded, transversely oriented forehead scalping flap in a pediatric patient. This approach not only provides a generous amount of forehead skin but also limits donor-site morbidity and scarring by orienting incisions transversely at the hairline and within the scalp.

Child↗