Tissue Expansion

Overview

Over the past 30 years or so, Tissue expansion has turned into a major reconstructive option to consider by both patients and surgeons. It has become more and more widespread, particularly in the fields of breast reconstruction, burn surgery, and pediatric plastic surgery. In many cases, tissue expansion can be said to have revolutionized plastic surgery.

Tissue expansion has numerous advantages. While it provides skin with a near-perfect match in color and texture, minimal donor site morbidity and scarring occur. It also can be used in various parts of the body to provide tissue with specialized sensory function or adnexal characteristics. Examples include the superior sensation of the skin flaps in breast reconstruction and the hair-bearing flaps designed in the treatment of male pattern baldness developed with expanders. In addition, expanded flaps are more resistant to bacterial invasion than random cutaneous flaps. This technique has been extended to other types of tissue, including bladder reconstruction, vascular elongation, and nerve lengthening.

Disadvantages include temporary cosmetic deformity during the expansion phase, prolonged period of expansion, the need for multiple procedures, and complications associated with the implant and placement.

Read more about : Facial plastic surgery

What Is Tissue Expansion?

Tissue expansion is a relatively straightforward procedure that enables the body to "grow" extra skin for use in reconstructing almost any part of the body.

A silicone balloon expander is inserted under the skin near the area to be repaired and then gradually filled with saline or carbon dioxide over time, causing the skin to stretch and grow. It is most commonly used for breast reconstruction following breast removal, but it's also used to repair skin damaged by birth defects, accidents, surgery and in certain cosmetic procedures.

If your doctor is recommending tissue expansion, this will give you a basic understanding of the procedure – when it can help, how it's performed and what results you can expect. It can't answer all of your questions, however, since much depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure.

Who Is a Good Candidate for Tissue Expansion?

Almost anyone in need of additional skin can benefit from tissue expansion -- from infants to elderly men and women.

. The procedure is used widely in breast reconstruction when there is not enough skin to accommodate a permanent implant to restore a woman's natural appearance.

. It is also an option for repairing or replacing areas of the scalp, where hair growth makes it difficult to replace lost tissue with skin from other areas of the body.

. Tissue expansion generally produces excellent results when reconstructing some areas of the face and neck, the hands, arms and legs.

. Expansion may be more difficult on the back, torso, or other areas where skin is thick. If the affected area is severely damaged or scarred, expansion is probably not an option since healthy skin is the first requirement.

What Are the Risks of Tissue Expansion?

Skin expansion can produce some remarkable results. As with any operation, though, there are risks associated with surgery and specific complications associated with this procedure.

The most common concern is that the silicone expander used in the procedure will break or leak while it is in the body. While expanders are rigorously tested and placed with care, leaks do occur. If the expander should leak, the salt-water solution (also known as saline) used to fill the expander is harmlessly absorbed by your system and the expander is replaced in a relatively minor surgical procedure.

A small percentage of patients develop an infection around the expander. While this may occur at any time, it's most often seen within a few weeks after the expander is inserted. In some cases, the expander may need to be removed for several months until the infection clears. A new expander can then be inserted.

Tissue expansion advantages

Until recently, surgeons were limited to skin flaps and skin grafts to reconstruct damaged tissue. Tissue expansion, however, provides an added technique with several advantages:

. Expansion offers a near-perfect match of color, texture and hair-bearing qualities

. Because the skin remains connected to the donor area's blood and nerve supply, there is a smaller risk that it will die

. Because the skin doesn't have to be moved from one area to another, scars are often less apparent

Tissue expansion disadvantages

On the other hand, skin expansion has one significant drawback – the length of time required to grow additional skin.

Depending on the area to be reconstructed, tissue expansion can take as long as three to four months. During this time, the expander creates what can be an unsightly bulge, which is desirable in breast reconstruction but can be quite noticeable for someone requiring repair of the scalp or other areas of the body. Furthermore, the procedure requires repeated visits to the surgeon for injection of the salt water that inflates the balloon. For some people, the inconvenience and obvious appearance of an expander are enough for them to consider other options.

What Are the Steps of a Tissue Expansion Procedure?

In most cases, the initial operation will take one to two hours, depending on the size and area of skin to be expanded. Your surgeon will insert the silicone balloon expander in a pocket created beneath the skin. The expander includes a self-sealing valve or gas cylinder that allows the surgeon to gradually fill the expander with saline or carbon dioxide.

Expander enlarges

Once the incision has healed, you'll be asked to return to your surgeon's office periodically so that the expander can be filled. As the expander enlarges, your skin will stretch. In some people, this procedure can cause minor discomfort.  The expander is filled by inserting a needle into the self-sealing valve, which may be under the skin, or by using a remote dosage controller to fill the expander with carbon dioxide.

Secondary operation

When the skin has stretched enough to cover the affected area, you'll have a second operation to remove the expander and reposition the new tissue. In breast reconstruction, the surgery required to remove the expander and insert the permanent implant is relatively brief. More complex surgery to repair skin on the face or scalp will take longer and may require more than one expansion sequence to complete.

. Scalp: Tissue expansion is ideal for scalp repair because the stretched skin on the scalp retains normal hair growth. Most other body tissue does not grow hair to the same degree.

. Breast: A silicone balloon expander is inserted beneath the skin. Once in place, the expander is gradually filled over time. When the tissue has grown to the desired amount, the expander is removed. In breast reconstruction, a permanent implant is then inserted.

. Arm: Expansion is also used to repair skin on the head and neck, hands, arms and legs.

What Should I Expect During My Tissue Expansion Recovery?

After your surgery

How you feel after surgery depends on the extent and complexity of the procedure. The initial surgery to insert the expander causes most patients only temporary discomfort which can be controlled with medication prescribed by your physician.

You may feel some minor discomfort each time saline is injected into the expander, but this usually lasts only an hour or two. The follow-up procedure to remove the expander and put the new tissue in place may create some temporary discomfort, but this too can be controlled with medication.

Getting back to normal

Again, how soon you resume your normal routine depends on the length, complexity and type of surgery you've had. For breast reconstruction patients, if tissue expansion is separate from breast removal, normal activity can resume in two to four days.

Most tissue expansion patients find they can keep up with their normal routine while the expander is in place. Following the second surgery, most patients are up and about within a week.

Your new look

Generally, the results of tissue expansion are superior to other methods used to reconstruct or repair damaged skin. But keep in mind, the goal is improvement, not perfection. For most tissue expansion patients, the procedure dramatically improves their appearance and quality of life following surgery.

If you're physically healthy, psychologically stable and realistic in your expectations, you'll probably be quite pleased with your new look.

Source:

https://emedicine.medscape.com/article/1822400-overview

https://www.plasticsurgery.org/reconstructive-procedures/tissue-expansion