Staged Scalp Soft Tissue Expansion Before Delayed Allograft Cranioplasty

2011 ◽  
Vol 71 (suppl_1) ◽  
pp. ons15-ons21 ◽  
Author(s):  
Ekkehard M. Kasper ◽  
Emily B. Ridgway ◽  
Amr Rabie ◽  
Bernard T. Lee ◽  
Clark Chen ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Expansion ◽  
Soft Tissue Defect ◽  
Successful Outcome ◽  
Skull Defect ◽  
Neurosurgical Procedure ◽  
Decompressive Hemicraniectomy ◽  
Second Stage ◽  
Cranial Defect ◽  
Complex Cases

Abstract BACKGROUND: Hemicraniectomy is an established neurosurgical procedure. However, before cranial vault reconstruction, it is imperative that sufficient scalp soft tissue is available for coverage of the reconstructed skull. OBJECTIVE: To present 2 complex cases of posttraumatic patients requiring soft tissue expansion of the scalp before definite cranioplasty with use of a synthetic polyethylene graft. METHODS: Two patients underwent decompressive hemicraniectomy for trauma and required delayed cranioplasty. Both patients had developed significant scalp contraction and presented with a paucity of soft tissue. These patients underwent a staged cranioplasty in which we first achieved scalp-tissue expansion adjacent to the craniectomy site over a prolonged interval. In a second stage, the patient underwent definite reconstructive surgery in which the subgaleal expanders were removed and polyethylene allograft cranioplasty was performed. RESULTS: Cutaneous coverage of the underlying defect could be achieved in this setting without causing tension on the incision line secondary to the now available excess scalp tissue. CONCLUSION: Repair of a cranial defect requires detailed attention to the available scalp and its size relationship to the skull defect to achieve a successful outcome with an aesthetically pleasing, reliable, and lasting result. Preoperative scalp tissue expansion is a valuable step in taking care of patients presenting with scalp soft tissue defect. This technique reduces the morbidity associated with conventional rotational and free-flap techniques.

scholarly journals Ten technical considerations revisited in tissue expansion

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Luke Geoghegan ◽  
Dariush Nikkhah
Keyword(s):  
Soft Tissue ◽  
Skin Flap ◽  
Tissue Expansion ◽  
Soft Tissue Defect ◽  
Illustrative Case ◽  
Soft Tissue Defects ◽  
Case Presentation ◽  
Versatile Tool ◽  
Technical Factors ◽  
Tissue Defects

Abstract Tissue expansion is a versatile tool in resurfacing soft tissue defects of the breast, extremity, head and neck that involves the placement of a temporary implant adjacent to a soft tissue defect. Incremental expansion exploits the viscoelastic properties of skin to generate a skin flap that can be used to resurface defects and provide cover over permanent protheses. Infection, implant extrusion and skin necrosis are recognized complications of tissue expansion. This article presents a revised framework of 10 technical factors to reduce the risk of complications and optimize outcomes with tissue expansion using an illustrative case presentation.

scholarly journals Repair of Soft Tissue Defect with Intraoperative Tissue Expansion after Surgical Resection of Dermatofibrosarcoma Protuberans: A Case Report

2021 ◽  
Vol 17 (3) ◽  
pp. 227-231
Author(s):  
Jin Soo Kim ◽  
Ilou Park ◽  
Sung Hoon Koh ◽  
Dong Chul Lee ◽  
Hee Jeong Lee
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Surgical Resection ◽  
Foley Catheter ◽  
Tumor Resection ◽  
Tissue Expansion ◽  
Dermatofibrosarcoma Protuberans ◽  
Soft Tissue Defect ◽  
Medical Setting ◽  
Tissue Defect

While it is the most frequently observed subtype of all cutaneous soft tissue sarcomas, dermatofibrosarcoma protuberans is still uncommon, with a high local recurrence rate. Although surgical resection could be a simple curative procedure, surgeons can encounter difficulties when dissecting or closing the wound, depending on the location and the size of the tumor. We present a case report of direct repair of soft tissue defect with intraoperative tissue expansion after sarcoma resection. A 62-year-old male visited our clinic with an approximately 1.5×1.5 cm-sized mass on his lower leg. We excised the mass, which a pathologic study confirmed as dermatofibrosarcoma protuberans. The authors planned a wide excision of the lesion as soon as possible. The excised lesion was not large; however, the soft tissue defect could not be closed by direct approximation. We eventually closed the tumor resection wound using a Foley catheter as a tissue expander. The patient’s wound healed well, albeit leaving a minimal scar. This case suggests that a Foley catheter could be an effective and versatile tool that is readily available in any medical setting, including after a small tumor resection in outpatient surgery.

scholarly journals Reconstruction of congenital microtia after ear canaloplasty using V-Y advancement of a temporal triangular flap

2021 ◽  
Vol 48 (6) ◽  
pp. 614-621
Author(s):  
Hae Yeon Park ◽  
Kyeong-Tae Lee ◽  
Eun-Ji Kim ◽  
Kap Sung Oh
Keyword(s):  
Soft Tissue ◽  
Costal Cartilage ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Median Number ◽  
Auricular Reconstruction ◽  
Second Stage ◽  
Triangular Flap ◽  
History Of ◽  
Bilateral Lesions

Background Reconstruction of congenital microtia remains challenging, particularly in patients with a history of ear canaloplasty due to insufficient regional soft tissue. The insertion of a tissue expander prior to implantation of the cartilage framework has traditionally been employed. However, this procedure could induce additional morbidity. Herein, we present a method using V-Y advancement of a temporal triangular flap to gain additional soft tissue in these challenging cases.Methods Congenital microtia patients with a history of ear canaloplasty who underwent auricular reconstruction using the Nagata technique between 2016 and 2020 were reviewed. To obtain additional soft tissue, V-Y advancement of a temporal triangular flap was performed concurrently with implantation of the costal cartilage framework, without prior insertion of a tissue expander. The outcomes of these patients with respect to postoperative complications and esthetics were evaluated.Results Eight patients with bilateral lesions were included. No specific complications developed after the first-stage surgery. However, one patient experienced complications after the second stage (auricular elevation). An analysis of the esthetic results showed most patients had excellent outcomes, achieving a satisfactory convolution. The median number of operations needed to complete reconstruction was 2, which was fewer than required using the conventional method with prior insertion of a tissue expander.Conclusions In patients with a history of previous canaloplasty, V-Y advancement of a temporal triangular flap could serve as an alternative to tissue expansion for microtia reconstruction. This technique provided reliable and satisfactory results with a reduced number of surgical stages.

scholarly journals Vein-Supercharged Peroneal Artery Perforator Propeller Flap for Achilles Soft Tissue Coverage

1970 ◽  
Vol 2 (2) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Laureen Supit
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Tissue Expansion ◽  
Soft Tissue Defect ◽  
Peroneal Artery ◽  
Soft Tissue Coverage ◽  
Aesthetic Result ◽  
Propeller Flap ◽  
Split Thickness Skin Grafting ◽  
Artery Perforator

Background: Wounds on the distal third of the lower extremity are reconstructively challenging, as there is lack of spare local tissue to design local flaps from. The perceived alternative is to perform free flaps to cover for these defects. Drawbacks include the need for specific training to perform microsurgery, longer time required, and the probable bulkiness when donor is obtained from certain areas. The perforator propeller flap is a local island fasciocutaneous flap, designed with 2 blades of skin island of unequal length extending from each side of the perforator. As the flap is rotated, the longer blade will cover the defect. Patient and Method: A case of soft tissue defect on the achilles is reported, with successful defect closure by utilizing a peronal artery perforator based fasciocutaneous propeller flap with 180 degree rotation and vein supercharge to facilitate backflow. Secondary defect required split-thickness skin grafting. Result: After surgery, muscles of the lower limb started to swell and get compromised. We removed some stitches to allow soft tissue expansion underneath the flap. after the release, flap perfusion improved. Stitches were left open for 3 days, then closure of flap edges by placing gradual traction sutures which were tightened daily. By the 7th day, flap edges was re-approximated and the skin grafts took well. Summary: The ability of the propeller flap to rotate makes this flap highly useful and versatile for the reconstruction of distal lower limb defects. Flap dimension can be enhanced when distal part of the flap is supercharged to neighboring recipient vessels. Another advantage is the close vicinity of donor, giving better aesthetic result.6

Heterodigital Free Flap of Index Finger Amputee for Coverage of the Long Finger Soft Tissue Defect

2013 ◽  
Vol 22 (2) ◽  
pp. 82-85 ◽  
Author(s):  
So-Min Hwang ◽  
Jang Hyuk Kim ◽  
Hong-Il Kim ◽  
Yong-Hui Jung ◽  
Hyung-Do Kim
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Index Finger ◽  
Soft Tissue Defect ◽  
Tissue Defect

scholarly journals No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone

2021 ◽  
Author(s):  
F. Wichlas ◽  
V. Hofmann ◽  
M. Moursy ◽  
G. Strada ◽  
C. Deininger
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Sierra Leone ◽  
Low Income ◽  
Soft Tissue Defect ◽  
Low Income Countries ◽  
Pelvic Surgery ◽  
Closed Fractures ◽  
Trauma Triage ◽  
Tissue Defects

Abstract Introduction In low-income countries (LIC), international surgeons face the fact that there are patients they cannot treat. The goal of this study was to identify and analyze patients lost to treatment. Material and methods We analyzed retrospectively the data of 282 trauma victims from a non-governmental organizational (NGO) hospital in Sierra Leone, Africa. During a 3-month period (10.10.2015–08.01.2016), these patients had 367 injuries and underwent 263 orthopedic surgeries. Despite a clear indication, some patients did not receive surgical treatment. We identified these injuries and the reason why they could not be operated. The anatomic region of the injury was evaluated and if they had a bone or soft tissue defect or were infected. Results We identified 95 (25.89%) injuries in 70 patients (47 males; 23 females) that were not be operated. The reasons were lack of specific implants (no implant group; N = 33), no treatment strategy for the injury (no solution group; N = 29), and patients that were lost (lost patient group; N = 33), almost equally distributed by 1/3. In the no implant group were mainly closed fractures and fractures of the pelvis and the proximal femur. The implants needed were locking plates (N = 19), proximal femoral nails (N = 8), and implants for pelvic surgery (N = 6). In the no solution group were nearly all bone (P < 0.0000), soft tissue defects (P < 0.00001) and infections (P = 0.00003) compared to the rest and more open fractures (P < 0.00001). In the lost patients group, most fractures were closed (24 out of 33, P = 0.033). These fractures were mostly not urgent and were postponed repeatedly. Conclusion One quarter of the patients did not receive the surgical treatment needed. Besides acquisition of implants, surgical skills and expertise could be a solution for this issue. Nevertheless, these skills must be passed to local surgeons.

scholarly journals Repair Exposure of the Postauricular Tissue Expander Using the Modified Brent Method: A 7-Year Experience

2021 ◽  
pp. 014556132110079
Author(s):  
Tongyu Cao ◽  
Qingguo Zhang
Keyword(s):  
Soft Tissue ◽  
Skin Flap ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Ear Reconstruction ◽  
Lower Pole ◽  
Tension Free ◽  
Subsequent Exposure ◽  
Free Closure ◽  
Complicated Conditions

Objectives: Ear reconstruction is a challenging surgery for the complicated conditions in patients with microtia. The tissue expansion techniques were necessary and relatively safe for patients with insufficient soft tissue. However, complications such as necrosis of expanded flap and exposure of tissue expander limited the popularization of this method. This study described the use of modified Brent method to handle the exposure of the postauricular tissue expander. Methods: From January 2013 to December 2019, 27 ear reconstruction patients with trauma or necrosis on an expanded skin flap and subsequent exposure of tissue expander were treated with modified Brent method, which consisted of 3 stages: removal of the expander, tension-free closure of wound, and framework fabrication; elevation of reconstructed ear; lobule rotation; and minor modification. Results: Fifty-six percent of exposures occurred in the lower pole of the tissue expander. Exposure usually occurred 54.5 days after implantation. The majority of reconstructed ears had a satisfactory appearance and showed relatively stable outcomes. Only one case of cartilage exposure required revision surgery and was repaired by the temporoparietal fascia. Conclusion: With reasonable distribution of expanded flap, prolonged interval, and sutures under tension-free conditions, complications like the occurrence of trauma or necrosis-induced exposure of tissue expander can be repaired efficiently by a staging modified Brent method.

Nanofiber-hydrogel composite–mediated angiogenesis for soft tissue reconstruction

2019 ◽  
Vol 11 (490) ◽  
pp. eaau6210 ◽  
Author(s):  
Xiaowei Li ◽  
Brian Cho ◽  
Russell Martin ◽  
Michelle Seu ◽  
Chi Zhang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Rabbit Model ◽  
Soft Tissue Defect ◽  
Fat Grafting ◽  
Foreign Body Response ◽  
Soft Tissue Reconstruction ◽  
Hydrogel Composite ◽  
Tissue Flaps ◽  
Tissue Restoration

Soft tissue losses from tumor removal, trauma, aging, and congenital malformation affect millions of people each year. Existing options for soft tissue restoration have several drawbacks: Surgical options such as the use of autologous tissue flaps lead to donor site defects, prosthetic implants are prone to foreign body response leading to fibrosis, and fat grafting and dermal fillers are limited to small-volume defects and only provide transient volume restoration. In addition, large-volume fat grafting and other tissue-engineering attempts are hampered by poor vascular ingrowth. Currently, there are no off-the-shelf materials that can fill the volume lost in soft tissue defects while promoting early angiogenesis. Here, we report a nanofiber-hydrogel composite that addresses these issues. By incorporating interfacial bonding between electrospun poly(ε-caprolactone) fibers and a hyaluronic acid hydrogel network, we generated a composite that mimics the microarchitecture and mechanical properties of soft tissue extracellular matrix. Upon subcutaneous injection in a rat model, this composite permitted infiltration of host macrophages and conditioned them into the pro-regenerative phenotype. By secreting pro-angiogenic cytokines and growth factors, these polarized macrophages enabled gradual remodeling and replacement of the composite with vascularized soft tissue. Such host cell infiltration and angiogenesis were also observed in a rabbit model for repairing a soft tissue defect filled with the composite. This injectable nanofiber-hydrogel composite augments native tissue regenerative responses, thus enabling durable soft tissue restoration outcomes.

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