Tissue Expander Reconstruction Research Articles

Tissue Expansion in Reconstruction of Postburn Contracture of the First Web Space of the Hand

The successful release of severe contracture of the first web space depends on addition of a sufficient amount of skin. Because local skin is limited, skin grafts tend to contract, and free and pedicle flaps are bulky, further procedures are often obligatory. Expansion of the tissues of the dorsum of the hand offers an effective and relatively simple approach to generate the excess skin needed. We present a patient in whom an inflatable silicone implant was used to correct recurrent first web space contracture after burns.

Tissue Expanders in Reconstruction of Burn Sequelae

In 20 patients with burn scars and 1 patient with a fresh burn, 33 tissue expanders were implanted. In 16 patients, the expansion fulfilled the goal set with the help of 27 expanders. The results are very satisfactory, but the effort of treatment and the trouble are substantial. Thirteen patients encountered no complications. In terms of expanders, there were 6 major and 11 minor complications. They were infection (three), wound dehiscence (two), insufficient expansion with hematoma (one), leakage (six), superficial skin damage (three), and intercurrent hematoma formation (two). There was no flap necrosis, and thus, apart from superfluous surgery, no real damage. Retrospectively, the major complications could have been avoided by more careful observance of indications. Unfortunately, this seems to be a process that every surgeon must learn by experience and not by theory alone. Here, infection was managed by removal of the expanders. Hematomas should be evacuated early (we drained most expanders), and incidences of leakage can be diminished by using larger valves. Small incisions in healthy tissue for expander insertion may lead to faster onset of expansion, thus, shortening the procedure. Late widening of scars was found only once, perhaps due to a rather long duration of expansion, averaging 13 weeks.

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.

The Role of Tissue Expansion in Reconstruction of the Ear

The following guidelines are suggested for the use of tissue expansion in ear reconstruction based on both personal experience and my evaluation of the reported results of expansion in the hands of other surgeons experienced in ear reconstruction: 1) Cases should be carefully selected to avoid those with excess scarring from previous surgery or trauma as well as avoid the other common contraindications to the use of tissue expansion. 2) In most congenital cases the expander should be placed through a remote incision within the postauricular hairline, and excision of the cartilage vestige delayed until expansion is completed and the framework is ready for placement. 3) A remote valve expander of a crescent shape with a volume of 60-100cc is ideal; low profile expanders may even be safer. 4) The pocket for the expander should be dissected immediately above the fascia and against the cartilage remnant. 5) Rapid expansion should be avoided; ideally injections should be carried out one time each week and with relatively small quantities (5-10cc per injection). 6) At the time of expander removal and placement of the cartilage framework the capsule should be meticulously excised to allow tight skin-cartilage coaptation. This is further enhanced by effective suction drainage following wound closure.

Tissue Expansion in Reconstruction of Acquired Auricular Defects

Over the past 10 years, tissue expansion has gradually become accepted as a useful adjunct to ear reconstruction with an autologous framework. The advantage of expanded tissue in these cases has been the addition of more tissue with similar color, texture, and sensation. In traumatic cases, the creation of well-vascularized tissue allows an improved anterior draping of skin over the cartilaginous framework and production of a well-defined posterior sulcus. Encroachment of hair onto the reconstructed ear is minimized because of the extra tissue produced by expansion. Under favorable conditions, tissue expansion is an acceptable and reliable method for partial or total ear reconstruction.

Extraoral placement of a subperiosteal tissue expander for reconstruction with hydroxylapatite of the severely atrophic mandibular alveolar ridge

A technique is described using a subperiosteal tissue expander and particulate hydroxylapatite for reconstruction of the class IV edentulous mandibular alveolar ridge. The expander is placed under direct visualization via an extraoral approach so that it can be precisely positioned with relation to the inferior alveolar nerve. A fibrous capsule, having ideal ridge structure forms around the expander, and hydroxylapatite can be injected into this capsule from the intraoral route. The rationale for this technique and its advantages are discussed. It has been used in 17 patients with excellent results.

Short-term experience with the subperiosteal tissue expander in reconstruction of the mandibular alveolar ridge

A review of 35 patients in whom a subperiosteal tissue expander was used before reconstruction of the alveolar ridge with hydroxylapatite granules is presented. The mean increase in mandibular height was 8.4 mm as measured on true lateral cephalometric radiographs. Secondary preprosthetic surgery was necessary in two cases.

Tissue expansion reconstruction of soft tissue avulsions of the face: Report of two cases

A technique utilized to increase the amount of skin available for repair of soft tissue defects with local flaps has been described. Indications for the use of tissue espansion and the surgical technique and possible disadvantages have been discussed. Two case reports are presented to illustrate the use of the tissue expander to repair avulsive craniofacial defects.

Tissue Expansion in Reconstruction

Tissue Expansion in Reconstruction