PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Tissue Expansion Devices”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
PubMed2006

Do metallic ports in tissue expanders affect postmastectomy radiation delivery?

PURPOSE: Postmastectomy radiation therapy (PMRT) is often delivered to patients with permanent breast implants. On occasion, patients are irradiated with a tissue expander (TE) in place before their permanent implant exchange. Because of concern of potential under-dosing in these patients, we examined the dosimetric effects of the Magna-Site (Santa Barbara, CA) metallic port that is present in certain TEs. METHODS AND MATERIALS: We performed ex vivo film dosimetry with single 6-MV and 15-MV photon beams on a water phantom containing a Magna-Site disc in two orientations. Additionally, using in vivo films, we measured the exit dose from 1 patient's TE-reconstructed breast during chest wall treatment with 15-MV tangent beams. Finally, we placed thermoluminescent dosimeters (TLDs) on 6 patients with TEs who received PMRT delivered with 15-MV tangent beams. RESULTS: Phantom film dosimetry revealed decreased transmission in the region of the Magna-Site, particularly with the magnet in the parallel orientation (at 22 mm: 78% transmission with 6 MV, 84% transmission with 15 MV). The transmission measured by in vivo films during single beam treatment concurred with ex vivo results. TLD data showed acceptable variation in median dose to the skin (86-101% prescription dose). CONCLUSION: Because of potential dosimetric effects of the Magna-Site, it is preferable to treat PMRT patients with permanent implants. However, it is not unreasonable to treat with a TE because the volume of tissue affected by attenuation from the Magna-Site is small. In this scenario, we recommend using 15 MV photons with compensating bolus.

Adult↗
PubMed2005

Treatment of inferior oblique paresis with superior oblique silicone tendon expander.

INTRODUCTION: Patients with inferior oblique eye muscle paresis may show hypotropia and apparent superior oblique muscle overaction on the side of the presumed weak inferior oblique (IO) muscle. We report 8 such patients successfully treated using unilateral silicone superior oblique (SO) tendon expanders. METHODS: Eight consecutive cases over the course of 6 years from the authors' private practice are described. None had a history of head trauma or a significant neurologic event. All patients showed IO paresis by 3-step test, with incyclotorsion and SO overacton of the hypotropic (paretic) eye. Forced ductions of the hypotropic eye were normal in all cases, and the vertical strabismus was treated with placement of a 7- mm silicone SO tendon expander in the hypotropic (paretic) eye. RESULTS: Mean preoperative primary position hypotropia was 6.5 prism diopters (PD); mean postoperative was 0.5 PD. Seven of 8 patients had resolution of primary position hypotropia, whereas the eighth was reduced. Mean preoperative SO overaction was 3+; all patients had postoperative resolution of SO overaction. Of 4 patients with preoperative ocular torticollis, mean preoperative head tilt was 9.3 degrees; mean postoperative tilt was 2.9 degrees. Two patients' head tilts had resolved, the other 2 showed improvement. All patients showed preoperative incylclotorsion of the hypotropic (paretic) eye; inclyclotorsion resolved in all patients after the placement of a SO tendon expander. CONCLUSION: The silicone SO tendon expander effectively restores ocular alignment in IO paresis with apparent SO overaction. Associated ocular torticollis can also be improved.

Adult↗
PubMed2006

Superior oblique tendon expanders with inferior rectus recessions for chin-up null point nystagmus.

Three patients with chin-up head postures caused by a nystagmus null point in downgaze were treated using bilateral superior oblique tendon expanders and inferior rectus muscle recessions. Preoperative chin-up head postures measured from 25 to 45 degrees. Postoperatively, 2 patients had complete resolution of their abnormal vertical head postures, and the third showed improvement.

Adolescent↗
PubMed2003

Imaging scleral expansion bands for presbyopia with optical coherence tomography.

A 57-year-old woman was treated for mild presbyopia with implantation of scleral expansion bands (SEB). Although near vision was temporarily restored, the effect dissipated after 1 year. Slitlamp-adapted optical coherence tomography (OCT) at 1310 nm allowed precise cross-sectional visualization of the hyporeflective intrascleral segments. The OCT method provided precise images of the segment depth and thickness, the scleral thickness at the scleral spur, the anterior chamber angle, and the angle-opening distance. Intrascleral tilting of 1 segment was seen; this required removal of the SEB because of marked foreign-body sensation. Noncontact, slitlamp-adapted OCT can be used to evaluate scleral changes after SEB implantation.

Female↗
PubMed2004

Evaluation of a satisfied bilateral scleral expansion band patient.

PURPOSE: To measure accommodation subjectively and objectively in a satisfied bilateral scleral expansion band patient. SETTING: University of Houston, College of Optometry, Houston, Texas, USA. METHODS: One bilateral scleral expansion patient (age 50 years), 9 age-matched normal presbyopic control subjects (age range 48 to 52 years), and 1 normal control subject (age 27 years) participated. The scleral expansion patient had a complete eye examination, corneal topography, and wavefront measurements 19 months postoperatively. Accommodation was measured subjectively with the push-up technique, minus to blur, and dioptric range of clear vision. Accommodation was determined objectively by measuring the accommodative responses to negative lenses and pilocarpine 6% with a Hartinger coincidence refractometer and to real targets with a dynamic infrared optometer. RESULTS: Distance and near acuity of 20/20 was achieved with +1.00 diopter (D) in the left eye, +0.50 D in the right eye, and a near add of +2.25 D. Corneal topography and ocular aberration measurements revealed no suggestion of optical multifocality. Subjective measurements resulted in accommodative amplitudes of 1.50 to 4.00 D, and objective measurements resulted in amplitudes of 0.25 to 1.33 D. The PowerRefractor showed an accommodative response of 0.50 D to stimuli of 1.00 to 4.00 D and strong pupillary constriction with accommodative effort compared with the control. CONCLUSIONS: No increase in accommodative amplitude above normal age-matched controls was found. Patient satisfaction may have come from the high expectations this patient had for a positive surgery outcome.

Accommodation, Ocular↗
PubMed2004

The use of tissue expanders in the closure of a giant omphalocele.

Giant omphalocele is associated with a high degree of visceroabdominal disproportion, which prohibits safe primary closure. Conventional treatment options include (1) topical therapy with epithelialization followed by secondary ventral hernia repair and (2) staged reduction using a SILASTIC(R) (Dow Corning, Midland, MI) chimney. The authors report a case in which staged reduction of a giant omphalocele was facilitated by the use of crescent-shaped tissue expanders positioned in the potential space between the internal oblique and transversus abdominis layers of the abdominal wall.

Abdominal Wall↗
PubMed2006

Management of giant omphalocele with rapid creation of abdominal domain.

BACKGROUND: The management of giant omphaloceles (GO) can be quite difficult when there is absence of abdominal domain. Coverage with delayed closure has been described. We present a technique to create an adequate peritoneal domain. METHODS: This is a retrospective review of our experience using an intraperitoneal tissue expander (IPTE) to create adequate abdominal domain in 2 patients with GO. RESULTS: In 2 children with unrepaired GO, an IPTE was placed into the pelvis and was inflated to the target volume over 3 to 4 weeks. At the definitive operation for the closure of the abdominal defect, the IPTE was removed, allowing reduction of all the viscera into the peritoneal cavity and achieving complete abdominal wall closure. The patients are now 1 year postoperative, each having a normal abdomen and enjoying normal growth and development. CONCLUSION: Intraperitoneal tissue expander placement can create the needed domain over several weeks in GO. Its use in 2 cases was associated with satisfactory complete abdominal wall closure in short order. This technique should be considered as a treatment option.

Child, Preschool↗
PubMed2006

Full-body impression technique for conjoined twins: A clinical report.

This clinical report describes a unique impression technique devised for fabrication of a full-body cast of conjoined twins. The authors describe how the cast was used by the medical team to plan the surgical flap design for effective abdominal wall closure during the 27-hour operation sequence that resulted in the twins' separation. The cast, in turn, proved invaluable in planning the complicated surgical procedures necessary to separate them.

Alginates↗
PubMed2000

TRAM flap breast reconstruction with expanders and implants.

Breast reconstruction has become an essential part of breast cancer management. The transverse rectus abdominis myocutaneous (TRAM) flap has replaced the prosthetic implant as the first choice for breast reconstruction. There are several incidences in which the volume of autogenous tissue cannot fulfill the requirements for symmetric reconstruction, especially in those patients with limited abdominal tissue and large ptotic breasts. The TRAM flap can be combined with tissue expanders and implants to obtain symmetry in these difficult reconstructive situations.

Adult↗
PubMed1995

Separation of conjoined twins.

Preparing for surgical separation of conjoined twins involves coordination, communication, and multidisciplinary planning by several specialties. This article discusses the embryology, etiology, and incidence of conjoined twins and provides a historical perspective of the different types of conjoined twins. A case study describes the perioperative management of conjoined twins at Texas Children's Hospital's, Houston. Team members' roles are discussed, and the perioperative care of conjoined twins detailed.

Anesthesia↗
PubMed2002

Implantation of scleral expansion band segments for the treatment of presbyopia.

PURPOSE: To assess the effects of scleral expansion band (SEB) segments on accommodative amplitude (primary measure), along with near and distance vision, refraction, pupil size and function, keratometry, axial length, intraocular pressure, contrast sensitivity, stereopsis, and other parameters (secondary measures) in a cohort of 29 emmetropic, presbyopic patients. DESIGN: Multicenter, prospective, nonrandomized, unmasked clinical trial in which the nonoperated eye served as the control. METHODS: Four polymethylmethacrylate segments were surgically implanted in quadrantic scleral pockets created in the dominant eye of 29 emmetropic patients who were between the ages of 51 and 60 (mean age 54). Patients were examined preoperatively and up to 6 months postoperatively. The aforementioned tests were performed on the operated and control eye of each patient. Data were analyzed using two-sided rank tests. Medians, means, and standard deviations are provided for all measurements. RESULTS: Accommodative amplitude was measured monocularly using a near-point "push" technique from both a 70-cm and 30-cm starting point. An increase in accommodative amplitude of surgical eyes by +1.7 +/- 1.5 diopters and +1.5 +/- 1.2 diopters, at these two testing distances, respectively, was noted at 6 months postoperatively (P <.0001). A smaller increase was also seen in control eyes (+1.2 +/- 1.1 diopters and +1.3 +/- 1.2 diopters, respectively). There was notable intercenter variation in gains in accommodation, with three of seven centers showing significant improvement in near-point accommodative amplitudes relative to the others (P =.0003). There was a median improvement of uncorrected near acuity in surgical eyes by 0.3 logarithm of the minimal angle of resolution (logMAR) at 30 and 40 cm and by 4 lines at 20 cm, with the difference in near acuity improvement at 6 months between SEB eyes and control eyes statistically significant at 20 cm (P <.030). Changes in spherical equivalence, axial length, and central keratometry readings were not statistically significant. There were no reports of anterior segment ischemia or malignant glaucoma. Adverse effects were limited to a transient elevation of intraocular pressure in one patient and misalignment of individual SEB segments, due to inadequate scleral pocket formation, in three patients. Only one SEB segment in one eye was replaced. It appears that the thickness and uniformity of the scleral belt loop is critical to the proper positioning and efficacy of the SEB segments. CONCLUSION: While the safety profile of SEB segments for the treatment of presbyopia was high, a modest improvement in near vision was noted in approximately half the patients using subjective methods of testing. The mechanisms that underlie improvement in near vision in the nonoperated eye await explanation. This may be due to a centrally controlled consensual response, potentiated convergence generating increased intravitreal pressure and hydraulic lift of the vitreo-zonular-lens diaphragm, or artifact from current testing techniques. Future studies of the SEB procedure should address the issue of intercenter variation by further standardizing and automating specific aspects of the surgical technique, as well as incorporating objective testing methods into the study design.

Accommodation, Ocular↗
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↗
PubMed1994

Use of expanded polytetrafluoroethylene in the repair of the difficult hernia.

Hernias that are not correctable by primary approximation require a prosthetic material to provide a tension-free repair. We report the results of 121 consecutive ventral (40) and inguinal (81) herniorrhaphies in 112 patients using the 2.0-mm expanded polytetrafluoroethylene (ePTFE) soft tissue patch. All follow-up was conducted by physical examination by the surgical team. Average follow-up was 49 months. Five patients (4%) experienced complications: there was 1 inguinal recurrence, 1 ventral recurrence, 1 seroma, 1 wound infection, and 1 prolonged gastrocutaneous fistula. The cause of one of the recurrences is unknown because the patient refused further surgery. The seroma resolved spontaneously after two aspirations. The remaining three complications were considered to be unrelated to the implantation of the prosthetic patch. There were no complications due to adhesions, bowel erosion, or bowel obstruction in the ventral repairs. On the basis of our clinical experience, we believe that ePTFE is an acceptable mode of treatment for all difficult hernias.

Follow-Up Studies↗
PubMed1996

A review of 120 Becker permanent tissue expanders in reconstruction of the breast.

In reconstructive breast surgery, the permanent tissue expander has become popular because it avoids expander-implant exchange and gives the patient some control over the final breast size. It may, however, be associated with a number of complications. We therefore analysed the clinical notes of 111 consecutive recipients of Becker breast expanders with respect to complications and their possible predisposing factors. 120 prostheses were inserted in 111 consecutive patients with a mean age of 42.6 years. Median follow-up was 12 months (range 8 to 22). The commonest indication was postmastectomy breast reconstruction (81%) followed by congenital hypoplasia (14%) and acquired breast asymmetry following repeated biopsies (3%). Overexpansion before size adjustment was achieved after an average of 8 expander inflations. Complications included capsular contracture (9%), local tumour recurrence (8%), wound dehiscence (8%), filling port failure (6%), infected prostheses (4.5%) and ruptured implants (1.6%). The significant predisposing factors to wound dehiscence/infection were heavy smoking and radiotherapy (P < or = 0.05, chi 2 test). Expansion rate was not a factor. 89% of patients expressed satisfaction with the final aesthetic result. Despite the excellent results obtained with this technique, caution must be exercised in heavy smokers and the previously irradiated.

Adult↗
PubMed1996

Breast reconstruction with anatomical expanders and implants: our early experience.

Dissatisfied with the upper pole fullness produced by the Becker expander/mammary prosthesis, we started using 'anatomically' shaped expanders and implants, as described by Maxwell, for breast reconstruction. We reviewed the results of our first 24 breast reconstructions in 19 patients, who were deemed suitable for reconstruction with this technique between August 1994 and April 1995 (9 months). The most commonly used expander was 500 cc (range 400-700 cc) and an average of 2.73 inflations was required before replacing the expander with a definitive implant. The minimum follow-up was 6 months. Few complications were recorded and all patients were very happy with the final result. We found that the anatomically shaped expanders and implants produced better aesthetic reconstructions compared to dome shaped prostheses. Importantly, the procedure was technically simple and the results readily reproducible.

Adult↗
PubMed1996

Correction of developmental breast abnormalities with a permanent expander/implant.

Patients with developmental breast abnormalities often present to the plastic surgeon at a young age. We report our experience with 4 cases of unilateral breast abnormality (3 hypoplastic and 1 tuberous) treated with a Becker permanent expander/implant. Our approach is to insert the expander/implant, expand intermittently to keep pace with growth of the other breast and remove the filling valve under local anaesthesia on maturity. The techniques and advantages of this approach are illustrated and discussed.

Adolescent↗