Rapid Intraoperative Tissue Expansion Research Articles

Scalp advancement for transgender women: Closing the gap.

Hairline advancement is a powerful procedure to shorten the forehead and eliminate areas of hair loss, especially along the temporal recesses. This study was undertaken to report the typical hairline advancement possible with the senior author's method for scalp advancement at the time of forehead feminization. Retrospective chart review. A review was conducted of 29 consecutive cases that met inclusion criteria from January to March 2018 at an academic medical center. Sex, gender, age, whether galeatomy was performed, and additional variables were recorded. The distance of hairline advancement was measured in the midline and at the left and right midpupillary line. Galeatomies and rapid intraoperative tissue expansion were performed as per standard surgical protocol. For the group of 29 individuals who underwent the specified method for scalp advancement, the average differences for the glabella to the trichion, the right midpupillary line, and the left midpupillary line were 1.90 cm, 2.07 cm, and 2.07 cm, respectively. These differences between the pre- and post-observations were statistically significant at the 0.1% level (P < .001). The overall average difference in scalp advancement was 2.01 cm (also significantly different pre- and post-measurements at the 0.1% level; P < .001). Our technique of hairline advancement provides a significant improvement in the hairline in patients seeking out advancement due to an elongated forehead while undergoing facial feminization. 4 Laryngoscope, 130:1431-1435, 2020.

Rapid Intraoperative Tissue Expansion with Latex Glove after Large Nevus Excision for a Pediatric Patient: A Case Report

Rapid Intraoperative Tissue Expansion with Latex Glove after Large Nevus Excision for a Pediatric Patient: A Case Report

Revising Large Scars

Large scars in the head and neck are often the cause of significant emotional distress to patients, and often present unique challenges to the plastic and reconstructive surgeon undertaking their revision. The primary goal of scar revision is to eliminate compromise of function that may have resulted from scar contracture; a secondary goal is to improve the appearance of the scar. Special techniques for the revision of large scars include serial partial excision, rapid intraoperative or prolonged tissue expansion, split- and full-thickness skin grafting, regional flaps, and free microvascular tissue transfer. Recent research has investigated the use of artificial skin and autologous fat grafting for large scar revision.

Rapid intraoperative tissue expansion can be used for scrotal reconstruction

Rapid intraoperative tissue expansion can be used for scrotal reconstruction

Scrotal Reconstruction Using Rapid Intraoperative Tissue Expansion: A Preliminary Report

Extensive scrotal skin loss can pose a difficult management problem. In most cases delayed scrotal approximation is feasible due to the redundancy of scrotal skin. However, large defects usually require reconstruction using flaps or grafts. We present a novel technique of scrotal closure using rapid intraoperative tissue expansion to manage select extensive partial scrotal defects. Between January 1996 and April 2006, 3 patients underwent delayed closure using rapid intraoperative tissue expansion for approximately 75% scrotal skin loss. Intraoperatively the residual lateral scrotal and medial thigh skin, and subcutaneous tissues were dissected, creating bilateral cavities for the placement of round 300 cc tissue expanders. Gradual inflation for a total of 20 minutes allowed adequate tissue expansion of the 2 thigh flaps, enabling tension-free scrotal closure. Each patient was followed for 12 months. The resulting reconstruction provided a tension-free, cosmetically appealing scrotum with complete testicular coverage. There were no perioperative or postoperative complications. Although rapid intraoperative tissue expansion has been successfully used for the closure of facial and extremity defects, to our knowledge it has not been described for genital skin loss. Our experience suggests that this relatively simple method is a viable addition to the reconstructive armamentarium in a select group of patients with extensive scrotal skin defects that are not amenable to scrotal approximation alone.

Identification of genes induced by rapid intraoperative tissue expansion in mouse skin

A method of rapid skin stretching, i.e. hemispherical load cycling with an inflated subcutaneous silicone balloon (Rapid Intraoperative Tissue Expansion or RITE), permits the surgeon to rapidly elongate skin and create a flap of greater length for reconstructive plastic surgery. We have previously developed an experimental mouse model to evaluate RITE, and have shown that rapid stretching prevents ischemia and significantly reduces necrosis. Although the advantages of RITE have been demonstrated both clinically and experimentally, the cellular and molecular mechanisms underlying these benefits were unknown. In the study reported here, we used differential display reverse transcription polymerase chain reaction to identify genes that are specifically induced by RITE. Among four differential gene fragments, the expression of one was confirmed by Northern blot hybridization. The cDNA fragment was extended and the resultant sequence analyzed to reveal induction of truncated long interspersed nucleotide element 1 (LINE-1 or L1). Truncated L1 elements are located inside introns of many genes and among these genes myotubularin and insulin I are known to regulate cell growth. Northern hybridization using specific cDNA probes for myotubularin and insulin I demonstrated that it also was induced by RITE. This is the first reported study to show that L1, myotubularin and insulin I are responsive to rapid hemispherical and not rapid linear stretch.

Intraoperative tissue expansion in eyelid reconstruction

Chronic tissue expansion is a well-accepted modality for increasing available tissue for reconstructive surgery. In rapid intraoperative tissue expansion (RITE), a tissue expander is used intraoperatively to increase the available tissue area for defect closure. The use of the ubiquitous and inexpensive Foley catheter has previously been reported as a tissue expander in RITE. In this paper, the authors examine the application of the Foley catheter for RITE in oculoplastic surgery. Case series. Twenty-six patients (ages 50 to 87) with eyelid defects from various causes underwent reconstruction using RITE. Using this technique, the tip of a #14 French Foley catheter is trimmed, keeping the balloon intact. The balloon is inserted under a skin-muscle flap. Counter traction is applied, and the balloon is filled with saline until the flap blanches. The balloon is inflated twice for 5 minutes with a 1- to 2-minute rest period between expansions. This provides increased tissue area for reconstruction of periocular defects. The linear extent of the eyelid defect was measured prior to and after expansion with RITE. A comparison was made between the two measurements. The linear extent of the eyelid margin defect decreased by 36% after RITE. Rapid intraoperative tissue expansion with a Foley catheter is a means of providing increased tissue area for reconstructive surgery of the eyelids and periorbital region. This technique provides excellent tissue match for color, texture, and thickness. The technique decreases the size of the incised and undermined skin-muscle flap and the tension needed for wound closure.

Assessment of survival and microscopic changes in porcine skin flaps undergoing immediate intraoperative tissue expansion.

The technique of rapid intraoperative tissue expansion has been used with increasing frequency in the clinical setting over the last several years. This technique takes advantage of the skin's ability to immediately stretch and increase in surface area when expanded under a constant load. Sixteen random-pattern, rapidly expanded skin flaps on 10 domestic male pigs were studied to assess the predictive value of the fluorescein test for flap viability after rapid intraoperative tissue expansion. Partial fluorescence was found to be a more accurate predictor of flap survival in the experimental rapidly expanded flaps when compared to full fluorescence. Partial fluorescence was found to under-predict flap survival by 0.3 to 0.5 cm, whereas full fluorescence was found to under-predict flap survival by 2.5 cm. Additionally, histologic and ultrastructural changes were examined in rapidly expanded skin from the hip region in three pigs. The only microscopic change noted between control and experimental flaps was dilated capillaries in the dermis of expanded skin, which was noted by electron microscopy. Collagen and elastic tissue changes were not demonstrated in rapidly expanded pig skin by electron microscopy, direct immunofluorescence, collagen, and elastic tissue stains.

Rapid intraoperative tissue expansion for closure of facial defects

Rapid intraoperative tissue expansion for closure of facial defects

Baker, S. R., and Swanson, N. A. Rapid intraoperative tissue expansion in reconstruction in the head and neck

Baker, S. R., and Swanson, N. A. Rapid intraoperative tissue expansion in reconstruction in the head and neck

Rapid Intraoperative Tissue Expansion for Closure of Facial Defects

Rapid intraoperative tissue expansion (RITE) has been shown to have definite applicability to reconstruction in the head and neck. However, widespread use of this modality has yet to be adopted by the otolaryngologic community. Believing that RITE might offer some advantages in the reconstruction of soft-tissue facial defects following Mohs micrographic surgery for cutaneous malignant neoplasms, we evaluated 30 consecutive patients referred for cosmetic reconstruction after Mohs micrographic surgery for the use of RITE. Eight patients were selected and underwent reconstruction using a total of 10 tissue expanders. Herein, we describe our experience with this initial series as well as some background and future applications of RITE.

Rapid Intraoperative Tissue Expansion in Reconstruction of the Head and Neck

A prolonged tissue expansion has the advantage of creating large amounts of additional skin for reconstructing cutaneous defects that might not be possible without the use of multiple, regional, distant, or microsurgical flaps. In spite of this, there are disadvantages, many of which can be circumvented by the use of rapid intraoperative tissue expansion instead. Although rapid expansion does not increase skin surface area as much as prolonged expansion, it may be helpful in assisting with closure of defects that might otherwise be problematic.