Immediate placement of tissue expanders in the management of large excisional defects on the face

Successful treatment of large forehead defect after the failure of tissue expansion: changing plan and strategy

Tissue expansion is an effective method in head and neck reconstruction for large defects. Tissue expansion allows enlarged local tissue for advancement or rotation flaps and could result in satisfactory aesthetic and functional outcomes. A 14-year-old boy presented with a 7 × 9-cm(2) traumatic defect on his forehead. We planned a 2-stage operation with tissue expanders. In the first operation, we placed two 100-mL crescent-type tissue expanders supraperiosteally through the scalp hairline incision. After the seventh postoperative day, failure of one of the expanders was found. Hence, we overexpanded the remaining expander using rapid inflation for 7 days (20 mL/d) and changed the plan of the flap design from a bilateral advancement flap to a supratrochlear artery-based unilateral rotational flap. The patient healed uneventfully and had satisfactory results 1 year postoperatively. To overcome tissue expansion failure, an overexpansion technique with multiple small crescent-type expanders was used; a rotational flap based on the supratrochlear artery is a good alternative method.

Tissue expansion: clinical applications

In this second article, the authors outline the process of reconstructive surgery using the tissue expansion technique described in the January 1995 issue of JWC.

A history of tissue expansion. Concepts, controversies, and complications

BACKGROUND

Tissue expansion has become a widely used adjunct in reconstruction of the skin.

OBJECTIVE

To trace the history of the concept of tissue expansion from the ancient to the latest medical literature.

METHODS

We reviewed the technologic developments in the materials and methods of tissue expansion.

RESULTS

Tissue expansion is of clinical importance and can be understood by the biochemical, biomechanical, and histologic features of expanded skin.

CONCLUSION

Tissue expansion is becoming widely used and accepted and its continued use under many circumstances is justified by the experimental and clinical results.

Chronic tissue expansion

BACKGROUND

Chronic tissue expansion is an extremely useful addition to the dermatologic surgeon's skills.

OBJECTIVE

To review chronic tissue expansion.

METHODS

The relevant literature is summarized. Two case histories are presented as examples of the utility of chronic tissue expansion.

RESULTS

The history of tissue expansion is briefly reviewed. Indications pertinent to the practice of dermatologic surgery are discussed. The devices themselves are described, as well as new experimental advances. The general procedure for utilizing tissue expanders is outlined, as well as relevant histologic changes that occur in expanded skin. Both common and rare complications are covered, with attention to prevention.

CONCLUSION

Chronic tissue expansion provides an excellent means for obtaining extra tissue for cosmetic and reconstructive surgery.

Cranio-maxillo-facial tissue expansion, experimentally based or clinically empiric? A review of the literature

The literature over 10 years covering tissue expansion in cranio-maxillo-facial surgery is reviewed. Since 1981, an evolving set of indications for application of the soft-tissue expansion technique has been published. However, it seems to be based much more on clinical experience (empiricism) than on the results of thorough experimental research. The direction of future research should be aimed at effects on bone, cartilage and mucosa at a microscopical level, and at the influence on growth and development of cranio-maxillo-facial structures.