Accelerated Tissue Expansion with the “Overfilling” Technique

Pietilä, J; Nordstrüm, Rolf E. A.; Virkkunen, Pekka; Voutilainen, Petri; Rintala, A

doi:10.1097/00006534-198802000-00011

Cited by 26 publications

(5 citation statements)

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“…The proponents for a more rapid expansion protocol suggest that the histological and autoradiographic studies of expanded skin demonstrate that a significant percentage of expanded skin is recruited from adjacent areas and that the bulk of new tissue formation occurs within the first several days following implant inflation. Experimental evidence supports the assertions that daily, 32,47,48 every second day, continuous, 49 or “overfilling” 50 inflation protocols take full advantage of the early histologic changes in expanded skin and achieve the same results as standard protocols in 80% less time without sacrificing flap viability. The augmented survivability of rapidly expanded flaps is ascribed to the mechanical stress and ischemia of the expansion process which better prepares the flap for the stress of flap advancement.…”

Section: The Rush For Rapid Expansionsupporting

confidence: 52%

A History of Tissue Expansion

Bennett

Hirt

1993

The Journal of Dermatologic Surgery and Oncology

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Section: The Rush For Rapid Expansionsupporting

confidence: 52%

A History of Tissue Expansion

Bennett

Hirt

1993

The Journal of Dermatologic Surgery and Oncology

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“…Mechanical creep refers to the viscoelastic ability of the skin to acutely stretch in an incremental fashion. Biological creep refers to the actual generation of new tissue secondary to a persistent, chronic stretching force 21. As mentioned above mechanical creep is one of the factors that makes direct closure under tension possible.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous eyelid expansion after full thickness eyelid resection and direct closure

Thaller¹

2001

British Journal of Ophthalmology

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Background/aims-Direct closure of eyelid defects gives excellent functional results but is usually restricted to defects measuring less than a quarter of the eyelid length for fear of distorting the palpebral aperture and compromising lid function. The authors have used direct closure in larger defects. The aim of this study was to establish the eVects of direct closure of full thickness eyelid margin defects under tension on the palpebral aperture dimensions. Methods-A consecutive series of patients who had undergone one eyelid, full thickness lid resection repaired by direct closure were identified and invited to have both eyes photographed. The palpebral apertures of both eyes were measured from the photographs by a masked observer. The amount of eyelid resected was recorded from the operation notes. The unoperated palpebral aperture was used as the control. The result were analysed using a paired samples t test. Results-The photographs of 18 patients were included in the analysis. The mean width of excised full thickness lid tissue was 15 mm (range 7-26 mm). The mean vertical palpebral aperture height was 9.2 (SD 1.4) mm in the operated eye as opposed to 9.3 (SD 1.2) mm in the non-operated eye. The mean horizontal palpebral aperture width was 26.1 (SD 1.9) mm in the operated eye as opposed to 26.4 (SD 1.8) mm in the non-operated eye. There was no statistically significant difference between the operated and unoperated horizontal and vertical palpebral measurements. Conclusions-Direct closure of large full thickness eyelid defects is possible in selected patients with excellent functional and cosmetic results. Eyelid tissue expansion occurs spontaneously following direct eyelid defect closure under tension, restoring the palpebral aperture dimensions.

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“…However, when the expansion pressure exceeds 235 mmHg it can compress tissue arterioles and reduce blood circulation to the flap. Thus, the swelling pressure alone would reduce blood perfusion [53]. The swelling pressures in Table 4, however, were obtained in an accelerated PLGA degradation condition.…”

Section: Resultsmentioning

confidence: 99%

“…After the expander has generated a flap of tissue, it must be removed to make space for the subsequent permanent implant or to use the tissue for closure procedures. The test methodology was adapted from techniques used in the food industry for semi-solid and hydrogel type materials [53–56]. In this case, the force required to press a ¼ inch steel ball through the fully swollen expander was divided by the expander thickness to generate a quantifiable description of the reshapable hydrogels post-swelling mechanical strength (Table 5).…”

Section: Resultsmentioning

confidence: 99%

Reshapable polymeric hydrogel for controlled soft-tissue expansion: In vitro and in vivo evaluation

Garner

Davidson

Eckert

et al. 2017

Journal of Controlled Release

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Tissue expansion is the process by which extra skin is generated using a device that applies pressure from underneath the skin. Over the course of weeks to months, stretching by this pressure creates a flap of extra tissue that can be used to cover a defect area or enclose a permanent implant. Conventional tissue expanders require a silicone shell inflated either by external injections of saline solution or air, or by internal osmotic pressure generated by a hydrophilic polymer. In this study, a shell-free tissue expander comprised only of a chemically cross-linked biocompatible polymeric hydrogel is developed. The cross-linked network of hydrophilic polymer provides for intrinsically controlled swelling in the absence of an external membrane. The new type of hydrogel expanders were characterized in vitro as well as in vivo using a rat-skin animal model. It was found that increasing the hydrophobic polyester content in the hydrogel reduced the swelling velocity to a rate and volume that eliminate the danger of premature swelling rupturing the sutured area. Additionally, increasing the crosslinking density resulted in enough mechanical strength of the hydrogel to allow for complete post-swelling removal, without the hydrogel cracking or crumbling. No systemic toxicity was noted with the expanders and histology showed the material to be highly biocompatible. These expanders have an advantage of tissue expansion without requiring an external silicone membrane, and thus, they can be cut or reshaped at the time of implantation for applications in small or physically constrained regions of the body.

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Accelerated Tissue Expansion with the “Overfilling” Technique

Cited by 26 publications

References 0 publications

A History of Tissue Expansion

A History of Tissue Expansion

Spontaneous eyelid expansion after full thickness eyelid resection and direct closure

Reshapable polymeric hydrogel for controlled soft-tissue expansion: In vitro and in vivo evaluation

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