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At least 109 records · Page 6Linked to original sources
PubMed2005

Use of a tissue expander and a polyglactic acid (Vicryl) mesh to reduce radiation enteritis: case report and literature review.

Management of stage IV rhabdomyosarcoma comprises systemic chemotherapy with local control by conservative surgery and radiotherapy. Abdominal radiotherapy may lead to radiation enteritis causing such serious morbidity as malabsorption, fistulae or stricture formation. The risk increases with the dose of radiation and length of bowel involved. Various methods have been utilised to displace the bowel from the radiation field. Usually these are applied in patients requiring pelvic irradiation. We report a case of metastatic alveolar rhabdomyosarcoma requiring radiotherapy to the right renal bed. Effective displacement of small bowel from the tumour site was achieved by a combined use of a tissue expander and Vicryl mesh. There were no complications from the surgery. This is the first report discussing combined use of a tissue expander and Vicryl mesh to aid radiotherapy to the renal fossa in a paediatric patient.

Biopsy↗
PubMed2000

Abdominal expansion using a polytetrafluoroethylene prosthesis in the treatment of Pepper syndrome.

The authors report three cases of stage IV-S neuroblastoma in infants aged 4, 6, and 8 weeks, who despite chemo- and radiotherapy required surgical intervention to urgently relieve major thoracoabdominal compression secondary to massive hepatomegaly. The results were successful, with abdominal expansion being achieved by the introduction of a polytetrafluoroethylene prosthesis, which was removed during the 2nd, 3rd and 7th postoperative month, respectively, after tumor regression. Two children were in complete remission 32 and 38 months later, the 3rd died after 16 months of tumor progression.

Adrenal Gland Neoplasms↗
PubMed2000

Repair of a giant omphalocele by a modified technique.

Large omphaloceles that contain centrally herniated liver pose challenges to surgical closure, the most significant being the space limitation of the abdominal cavity. In addition, the "pedicled" nature of the liver on the inferior vena cava creates a predisposition to acute hepatic vascular outflow obstruction as the liver is reduced into the abdominal cavity. In such cases, the alternatives include conservative treatment or staged silo reduction. The worst complication of silastic silo (SS) placement is tension and infection of the fascia with disruption of the suture line. Once infection or premature disruption occurs, closure of the defect is difficult or impossible. This case report details a different management technique for a newborn with a giant omphalocele and presents an interesting variation of the usual SS technique that may be helpful in the management of some cases, especially in an emergency. The thick silk sutures applied in the present case absorbed the tension and the silastic sheet prevented the risks of infection and adhesions.

Abdominal Muscles↗
PubMed2004

First experience of endoscopic implantation of tissue expanders in plastic and reconstructive surgery.

BACKGROUND: Over the last 15 years, tissue expansion has been used in the treatment of 324 patients at the A. V. Vishnevsky Institute of Surgery. The principal drawbacks of the traditional technique for tissue expansion are the prolonged time needed to complete the process and a high rate of complications. With the traditional technique, the wound created by the implantation of the expander inhibits the expansion of the tissue until healing takes place, which requires 10-14 days. However, attempts to reduce of the length of the incision have been limited by the necessity to ensure good hemostasis in the expander pocket. We describe our initial experience with the endoscopic insertion of tissue expanders. METHODS: We performed the endoscopic implantation of 20 tissue expanders in nine patients. Six patients had postburn scar deformities, one had congenital microtia, one had a capillary malformation, and one had a capillary malformation combined with postburn scar deformity. Tissue expanders were inserted in the head, face, neck, chest wall, scapular, shoulder, forearm, and calf regions. The endoscopic technique was specially adapted according to the features of the different anatomic sites. Endoscopy enabled creation of the expander pocket, with good control of hemostasis, through incisions < or =1 cm. The orientation of these incisions was parallel to forces of tension. Therefore, full expansion began immediately after placement of the expander, without any risk of postoperative wound dehiscence. The expanders were fully inflated intraoperatively accordingly to the principals followed in the traditional technique of implantation for inflation over a 3-week period. Further inflations were carried out regularly either daily or once every other day. RESULTS: The average time required for the tissue expansion was 34 days, which was less than half the time needed with the traditional technique. All flaps remained extant after reconstruction with the expanded tissues. There were no complications. CONCLUSION: The advantages of the endoscopic implantation of tissue expanders are a reduction in expansion time, a shorter hospital stay, less patient discomfort, and the prevention of complications (hematoma, seroma, infection, wound dehiscence).

Adolescent↗
PubMed2002

Augmentation with a Gore-Tex patch for repair of large rotator cuff tears that cannot be sutured.

The objective of this study was to determine the effectiveness of augmentation with a Gore-Tex patch in reconstruction of rotator cuff tears that cannot be repaired by direct suture. Twenty-eight shoulders of 27 patients underwent this procedure. The average age at surgery was 62 years, the average duration of symptoms before surgery was 16 months, and the average follow-up period was 44 months. The shoulders were classified into two groups according to patch size (anteroposterior dimension up to 2 cm or greater than 2 cm). The clinical outcome was evaluated by using the shoulder surgery classification system issued by the Japanese Orthopaedic Association (JOA score), and the postoperative isometric abduction strength at 90 degrees of abduction was assessed by the method of Constant. The average total JOA score improved from 57.7 to 88.7 points, a statistically significant change. There was no difference in the improvement in score between shoulders treated with small patches (12 shoulders) and those treated with large patches (16 shoulders). The average abduction strength was 6.2 kg in the small-patch group and 1.5 kg in the large-patch group, with a statistically significant difference between the two groups. Good clinical results, especially pain relief, could be achieved with this procedure in both the small- and the large-patch groups, but good abduction strength was obtained only in the small-patch group. The mechanism of the improvement by this procedure is still controversial.

Adult↗
PubMed2001

An outcome study of breast reconstruction: presurgical identification of risk factors for complications.

BACKGROUND: Breast reconstruction following mastectomy has been shown to have a salutary effect on the overall psychological well-being of women being treated for breast cancer. Unfortunately, however, not every patient is an ideal candidate for reconstruction. Complications stemming from reconstructive surgery can cause significant morbidity, the most important of which may be the delay of subsequent adjuvant antineoplastic therapies, and therefore may not be in the best interests of the patient. METHODS: A retrospective study was performed on a consecutive series of 123 breast reconstructions in 98 patients, performed by one of two plastic surgeons, in a university setting over a 5-year period, for all surgical outcomes. Specifically, wound-healing complications, infections, and reoperations leading to the potential delay of subsequent chemotherapy or radiotherapy were recorded, and possible risk factors leading to these were sought. RESULTS: Three presurgical risk factors were found to have a statistically significant influence on the development of complications following breast reconstruction. These were: (1) increasing obesity, defined by the body mass index, (2) an active or recent (<5 year) history of cigarette smoking, and (3) a history of previous radiation exposure. Odds ratios were used to describe the magnitude of the effect of each factor for the development of complications. An ordinal regression analysis was used to create a nomogram based on this information that can be used to calculate any individual patient's presurgical risk for developing major complications following breast reconstruction, based on the presence of these factors. CONCLUSIONS: It is possible, based on the presence of specific presurgical risk factors, to predict the probability of developing major complications following breast reconstruction. This information can be useful to the referring physician and plastic surgeon alike in determining which patients are the best candidates for breast reconstruction and which type of reconstruction would be best suited for each individual patient.

Adult↗
PubMed2005

Plastic surgical approaches for HIV-associated lipoatrophy.

Prolonged antiretroviral therapy, particularly with thymidine analogue-based regimens, may lead to generalized lipoatrophy. The facial changes associated with lipoatrophy are highly stigmatizing, affecting quality of life and decisions around therapy. Changes in antiretrovirals to thymindine-sparing regimens may lead to gradual fat recovery but, even over several years, may not result in impressive restoration of appearance. The need for a rapid and effective panacea for facial changes has led to investigation of a range of cosmetic treatments to enhance facial appearance. Surgical fillers, which may be either permanent or biodegradable, are the mainstay of cosmetic management. These treatments not only lead to improved physical appearance but also may reduce social anxiety and depression.

Absorbable Implants↗
PubMed1990

Right pneumonectomy syndrome in infancy treated with an expandable prosthesis.

Severe respiratory distress developed in a 5-month-old infant approximately ten days after pneumonectomy for complete sequestration of the right lung. Right pneumonectomy syndrome was diagnosed by bronchography, which revealed thinning and obstruction of the left main bronchus during expiration. A right thoracotomy was then performed, and an inflatable tissue expander with a subcutaneous injection port was inserted into the right chest cavity to prevent recurrence of the mediastinal shift and to allow for future growth. The patient has done well, requiring reinjection of the prosthesis with additional volume on one occasion in a 20-month period of follow-up.

Airway Obstruction↗
PubMed1990

The use of tissue expanders in immediate breast reconstruction following mastectomy for cancer.

From April 1985 to March 1987, 50 women had 56 mastectomies for documented cancer. A tissue expander was used for immediate reconstruction in each case. The patient records were used to determine morbidity and mortality, as well as to examine the effect of reconstruction on adjuvant therapy, cancer surveillance, adequacy of cancer surgery and patient satisfaction. The patients were followed up for an average of 13 months. Fifty-two of 56 expanders were successfully replaced with a permanent prosthesis. Forty-seven women remain alive. Local or regional recurrence did not occur in any women within the study period. Complications, of which superficial skin necrosis was most common, occurred in 35% of reconstructions and were investigated critically. Patient satisfaction was high. Dissatisfaction was not related to the incidence of complications but rather appeared to reflect the success of the patient's cancer treatment.

Adult↗
PubMed1990

Biomechanical and histomorphological changes in expanded rabbit skin.

In 12 rabbits, biomechanical and histomorphological properties were determined in expanded, sham-operated and non-operated control skin. Results were evaluated in paired fashion. Both expanded and sham-operated skin showed a significant loss of stiffness of 60% and 35% respectively (rho less than 0.001 and rho less than 0.05). In addition, maximum stiffness in expanded skin was reached at a shorter extensibility than in sham-operated or non-operated control skin. Histomorphological examination revealed thickened dermal collagen bundles with loosened packing of collagen fibrils in both expanded and sham-operated skin. It is concluded that the surgical procedure of balloon implantation is responsible for a significant part of the reported biomechanical and histomorphological findings. Wound healing, in addition to the delay phenomenon, may therefore be a mechanism involved in skin expansion.

Animals↗
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↗
PubMedDate not supplied

Surgical delay of expanded skin flaps in lower limb resurfacing.

We report the details of a patient in whom three expanded random pattern skin flaps were raised and transposed to repair lower limb defects. The importance of an additional surgical delay procedure is introduced and its efficacy is demonstrated.

Adult↗
PubMedDate not supplied

Repair of "coup de sabre" with tissue expander.

Two cases of coup de sabre, a linear form of scleroderma, treated by means of tissue expansion, are discussed. Expanded skin flaps on the scalp and forehead provided sufficient skin and tissue for closure of the defect after resection of the defect, and good results were obtained.

Adolescent↗
PubMedDate not supplied

Breast hypoplasia.

Explore the source record for details and available documents.

Adult↗
PubMed1991

Pain and forehead expansion.

Tissue expansion of the forehead by intermittent bolus injection in three patients was noted to be extremely painful. This stimulated a prospective study in four patients whose discomfort was found to be related to a sharp rise in intraluminal pressure after bolus inflation. Tolerable infusion volumes were small (mean 6.25 cc) and associated with high pain scores (mean 7/10). Adequate expansion was protracted (mean 45 1/2 days) and was limited by pain. To eliminate the sharp rises in pressure associated with expansion by bolus injection, a syringe pump was used in two further inpatients. Adequate expansion was both quicker (mean 8.5 days) and less painful (mean pain score 2.6/10).

Aged↗
PubMedDate not supplied

Delay between expansion and expander/implant exchange in breast reconstruction--a prospective study.

It has been suggested that delay between expansion and insertion of the definitive prosthesis in breast reconstruction reduces the incidence of adverse capsular contracture. We have carried out a prospective trial to examine this hypothesis. 65 patients were randomly allocated into two groups; in one, insertion of the definitive prosthesis was 2 weeks following expansion ("immediate") and in the other, 6 months ("delayed"). The incidence of adverse capsular contracture assessed both by the Baker Scale and a linear analogue scale showed no difference between the two groups. A new objective method for measuring ptosis using a specially designed template is described. The degree of ptosis was not affected by the delay.

Adult↗
PubMed1993

A cheap and efficacious intraoperative tissue expander.

The application of a mass produced antral balloon catheter for intraoperative tissue expansion in the head and neck is described. This balloon catheter has the advantage of being cheap and readily available.

Catheterization↗