유방재건술에서 조직확장기 감염의 위험인자

한승범,이동원,유대현 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.5

Purpose: Implant-based breast reconstruction has multiple advantages such as decreased morbidity, shorter operative time and faster recovery. However, postoperative infection with tissue expander increases medical cost and causes a delay in concurrent antineoplastic treatment. To reduce tissue expander infection, it is important to identify related risk factors and minimize them when possible. Methods: A retrospective review of patient records in a single breast cancer center was performed. Eighty-six tissue expanders were placed in 80 women for postmastectomy breast reconstruction. Variables including patients’age, body mass index(BMI), preoperative breast volume, operation time, drain indwelling time, postoperative seroma/hematoma formation, chemotherapy, and radiation therapy were evaluated. Infection was defined as the status that shows any symptom of local inflammation and identification of pathogens. Representative values were compared through Student’s t-test and univariate and multivariate analyses. Results: We examined 86 postmastectomy tissue- expanders which were placed between June 2004 and April 2010. Seven cases of tissue expander infection (8.1%) were identified. The infected tissue expander was removed in three of the cases. The relationship between BMI, and preoperative breast volume and that between infection and non-infection groups were significant(p< 0.05). Univariate analysis showed significant association between BMI(p=0.023) and preoperative breast volume (p=0.037). Multivariate analysis revealed that BMI and preoperative breast volume were independent variables regarding tissue expander infection. Conclusion: Certain characteristics of implant-based breast reconstruction patients increase infection rate of tissue expander. These risk factors should be monitored and evaluated before surgeries for more successful outcome.

조직확장기의 반투과성에 대한 임상적고찰

노정식,홍인표,심영기,이세일 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.5

Tissue expansion has been used widely, but many fundamental scientific questions remain unclarifield. There has been some short discussions concerning the leakage from a saline-filled tissue expanders. This in vivo study was undertaken to find out under which conditions such leaskage occurs and what clinical significance it has. Anthors performed tissue expansion in 31 patients from June 1990 to January 1991, using 50 tissue expanders. After the expected tissue expansions was achieved, we measured the total amount of saline at the time of the removal and compared it with the cummulative amount of saline injected during the period of tissue expansion. We found that there were an appreciable fluid loss in most expanders during the period of expansion. The average fluid loss is 5.5% of the original volume, ranging from 0.4% to 12.1%, and it varied upon the location of expanders duration and amount of expansion. Semipermeability of the silicone membrane can explain the leakage from a saline-filled tissue expander, particularly in an increased internal pressure.

Scarred scalp reconstruction with a rectangular expander

Shin, Hyojeong,Shin, Jeonghwan,Lee, Jun Yong Korean Cleft Palate-Craniofacial Association 2020 Archives of Craniofacial Surgery Vol.21 No.3

Scalp reconstruction is challenging because the scalp is inelastic, stiff, and has hair follicles. Tissue expansion offers aesthetically pleasing outcomes with minimal donor-site morbidity. However, in a scarred scalp, the extent of possible dissection for the expander insertion may be limited and surgeons must make use of the limited scalp tissue. We successfully reconstructed scarred scalps using rectangular expanders. This report presents two cases: a 4×3 cm chronic defect with widespread scarring and osteomyelitis and an 11×7.5 cm scar tissue following a skin graft. Tissue expanders were inserted in the subgaleal plane and were inflated by 195 mL and 400 mL over periods of 2 and 3 months, respectively. Subgaleal elevation of a fasciocutaneous flap was achieved with the expanded tissue. The defects were well covered, with good color, texture, and hair-bearing tissue. There were no complications involving the tissue expanders. Rectangular expanders yield more available tissue than round or crescent-shaped expanders. Moreover, since the base of the flap is well defined, the expander can be easily inserted in a limited space. Therefore, rectangular expanders are recommended for the reconstruction of scarred scalps.

Improvement of fibrosed scar tissue elongation using self-inflatable expander

Jung, Gyu-Un,Kim, Jin-Woo,Pang, Eun-Kyoung,Kim, Sun-Jong The Korean Dental Association 2016 대한치과의사협회지 Vol.54 No.7

We evaluated a self-inflatable osmotic tissue expander for its utility in creating sufficient soft tissue elongation for primary closure after bone grafting. Six patients with alveolar defects who required vertical augmentation of >6 mm before implant placement were enrolled. All had more than three prior surgeries, and flap advancement for primary coverage was restricted by severely fibrosed scars. Expanders were inserted beneath the flap and fixed with a screw. After 4 weeks, expander removal and bone grafting were performed simultaneously. A vertical block autograft and guided bone regeneration and distraction osteogenesis were performed. Expansion was sufficient to cover the grafted area without additional periosteal incision. Complications included mucosal perforation and displacement of the expander. All augmentation procedures healed uneventfully and the osseous implants were successfully placed. The tissue expander may facilitate primary closure by increasing soft tissue volume. In our experience, this device is effective, rapid, and minimally invasive, especially in fibrous scar tissue.

Improvement of fibrosed scar tissue elongation using self-inflatable expander

정겨운,김진우,방은경,김선종 대한치과의사협회 2016 대한치과의사협회지 Vol.54 No.7

We evaluated a self-inflatable osmotic tissue expander for its utility in creating sufficient soft tissue elongation for primary closure after bone grafting. Six patients with alveolar defects who required vertical augmentation of >6 mm before implant placement were enrolled. All had more than three prior surgeries, and flap advancement for primary coverage was restricted by severely fibrosed scars. Expanders were inserted beneath the flap and fixed with a screw. After 4 weeks, expander removal and bone grafting were performed simultaneously. A vertical block autograft and guided bone regeneration and distraction osteogenesis were performed. Expansion was sufficient to cover the grafted area without additional periosteal incision. Complications included mucosal perforation and displacement of the expander. All augmentation procedures healed uneventfully and the osseous implants were successfully placed. The tissue expander may facilitate primary closure by increasing soft tissue volume. In our experience, this device is effective, rapid, and minimally invasive, especially in fibrous scar tissue.

조직확장법,술중 조직확장법 및 술전 봉합법의 임상적 응용에 관한 비교 연구

오석준,하지운,김응춘,서인석,조세흠 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.3

The purpose of soft tissue defect reconstruction is minimal scar with aesthetic and functional good results. Reconstruction of head and neck, upper extremity, chest, and lower extremity defects has been reported with standard available tissue expansions. Various surgical methods have been used in an attempt to achieve a normallooking skin color, texture, sensation, thickness and same skin adenexa. Therefore, in accordance with defect size and location, the operative method was considered so we select adequate method. Authors achieved good results from 48 cases of tissue expansion, 18 cases of ISLE (intraoperative sustained limited expansion), and 35 cases of presuturing technique. 1)The most common cause of reconstruction for soft tissue defect was post grafted scar 51cases(51%), next was tattoo 20 cases(19.6%), traumatic soft tissue defect 16cases(15.7% ) and nevus 8 cases(7.8%)in order. 2)Males(55.9%)were affected more often than females(44.1%)in the ratio 1, 3 : 1 and the most frequently affected group was the age of 20 to 30 years as 36% . 3)The distribution of incidence and location were as follow : face(39.2%), upper extremity(25.5%), scalp(17.6%), lower extremity(9.8%) and trunk(7.8%). 4)The cause and distribution were scalp in 20 cases(39.2%), face in 40 cases(29.4%) in the post grafted scar, upper extremity 18 cases(90.0%) in the tattoo, upper extremity 4 cases(50.0%), face 2 cases(25.0%) in the nevus and even distribution in the traumatic soft tissue defects. 5)The presuturing technique was best recommended method for soft tissue defect in 4cm diameter lesion on extremity, but ISLE method was used in the open traumatic soft tissue defect. Over 9cm wide scar was resurfaced by expanded skin using tissue expander.

Improvement of fibrosed scar tissue elongation using self-inflatable expander

Gyu-Un Jung,Jin-Woo Kim,Eun-Kyoung Pang,Sun-Jong Kim 대한치과의사협회 2016 대한치과의사협회지 Vol.54 No.7

We evaluated a self-inflatable osmotic tissue expander for its utility in creating sufficient soft tissue elongation for primary closure after bone grafting. Six patients with alveolar defects who required vertical augmentation of >6 mm before implant placement were enrolled. All had more than three prior surgeries, and flap advancement for primary coverage was restricted by severely fibrosed scars. Expanders were inserted beneath the flap and fixed with a screw. After 4 weeks, expander removal and bone grafting were performed simultaneously. A vertical block autograft and guided bone regeneration and distraction osteogenesis were performed. Expansion was sufficient to cover the grafted area without additional periosteal incision. Complications included mucosal perforation and displacement of the expander. All augmentation procedures healed uneventfully and the osseous implants were successfully placed. The tissue expander may facilitate primary closure by increasing soft tissue volume. In our experience, this device is effective, rapid, and minimally invasive, especially in fibrous scar tissue.

연부조직 손상환자에서 조직 확장기를 이용한 슬관절 전치환술

하철원(Chul-Won Ha) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.7

슬관절 전치환술시 주변 연부조직의 상태는 수술 후 감염의 예방 및 결과에 있어서 매우 중요하다. 슬개골의 개방성 골절에 의한 감염 및 수 차례의 수술로 인하여 슬관절 전면부가 광범위한 반흔 조직 및 매우 불량한 연부 조직으로 덮여있고, 강직을 동반한 슬관절에서 조직 확장기(tissue expander)를 이용하여 피부 및 주변 연부조직을 확장한 뒤에 인공 슬관절 치환술을 시행하여 만족할만한 결과를 얻었기에 문헌고찰과 함께 증례 보고한다. 슬관절 주변의 연부조직이 매우 불량한 환자에 있어서 조직확장기를 이용한 슬관절 전치환술은 감염이나 수술 후 연부조직과 관련된 합병증 없이 만족스러운 결과를 얻을 수 있는 좋은 방법으로 사료된다. In total knee arthroplasty, the status of the soft tissue around the knee joint is important in preventing soft tissue complications and post-operative infection to obtain good results. This article reports a patient, who presented with a stiff knee joint and poor soft tissue coverage as a consequence of several operations after an open patellar fracture. The patient underwent total knee arthroplasty after an expansion of the skin and adjacent soft tissue using a tissue expander. The TKA results were satisfactory without any soft tissue complications including infections or skin necrosis.

The influence of tissue expanders on grafted vessels

Lee, Sang Heon,Hong, Chull,Futrell, J. William Yonsei University, College of Medicine 1989 Yonsei medical journal Vol.30 No.4

영구 피부확장 보형물 (Permanent Expander Breast Prosthesis)을 이용한 즉시 유방재건술의 임상적 경험 및 문제점

김진영,양원용,고석환,이두형 대한미용성형외과학회 1998 Archives of Aesthetic Plastic Surgery Vol.4 No.1