반흔구축의 교정을 위한 반흔조직확장술

한상백,박철규,이윤호,민경원 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.2

The treatment of scar contracture has a relatively long history in the department of plastic surgery. Flap surgery, including Z-plasty and skin graft has been a common surgical modality for the treatment of scar contracture. However, the 'deficiency' of the tissue is basically responsible for the limitations of this treatment. The concept of tissue expansion has contributed to the solution of tissue deficiency and thus tissue expansion is currently widely used for various purposes in plastic and reconstructive surgery. Nevertheless, tissue expansion has not yet clearly solved the problems in cases of seven deficiency of surrounding normal tissues, or in cases of multiple and diffuse scar contracture. We have tried to 'expand the scar tissue' to overcome these limitations. The authors 'several decades of experience in tissue expansion has taught us to find the usefulness of incidentally expanded scar tissues. Thirty-one patients with scar contracture urderwent expansion of surrounding normal and/or scar tissues, including 5 cases of pure scar tissue expansion. The postoperative results were satisfactory with a minimal complication rate. In conclusion, scar tissue expansion was usefully applicable for the scar contracture with no surrounding normal tissues. Scar tissue could be expanded safely and sufficiently, designed to various flaps, and the flap survival was reasonable. The functional and aesthetic quality of the scar tissue seems to improve following tissue expansion. In addition, meticulous planning is essential from the initial operation, including the area of expander insertion, flap design considering the aesthetic unit and functional aspect.

조직확장기를 이용한 급성 동맥연장의 방법에 관한 연구

박홍식,김석화,김현철 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.4

Since the modern technique of tissue expansion was first introduced, it has been proved to be a safe and effective technique for obtaining extra tissue where distant flaps and grafts has been used traditionally. The vascular defects have been restored by autogenous vein graft or artificial vessel, such as Gortex. However, in the case of small vessel(diameter<1 mm) defects, no single ideal substitute has been established, although experimental trials of artificial vessel grafts have been performed. The most ideal method in restoring vascular defects is to dissect both sides of the defective vessel and obtain the primary anastomosis, if the size permits. In case the primary anastomosis is not available, autovenograft or artificial vessel grafts are tried. If the lengthening of the vessels is possible, then the additional task of obtaining a donor vessel can be avoided and will be free from the complications of the donor sites. Furthermore, it is expected that this method will help solve the problems applying artificial vessels to small vascular defects(diameter<1 mm). This study demonstrates a method which is safe and effective in the acute extraluminal expansion to elongate the arteries intraoperatively. Ten Sprague-Dawley rats were divided into 4 groups according to the difference of time in exploration for checking the patency of elongated arteries: immediately after expansion, 48 hours after expansion, I week after expansion, and 2 weeks after expansion. We compared the efficacy of CTE(Continuous Tissue Expansion) versus ISLE(Intraoperative Sustained Limited Expansion) in the arterial lengthening group with the volume of 5 cc expansion. A miniaturized tissue expander was used to stretch the left femoral artery in three consecutive cycles of over a 15-minute period, and continuous tissue expansion over a 15-minute period using infusion pump(Terumo syringe pump model STCO523) was used to stretch the right femoral artery of the same rat. There were no difficulties in the tissue expander technique in acute aterial lenghtening. We found that all the elongated arteries were patent: immediately, 48 hours, 1 week, and 2 weeks after expansion, ISLE gained about 10.08% in length, while CTE gained about 6.5%(P<0.02). In conclusion, with the maximum recommended volume of expansion in acute arterial lenghthening, ISLE and CTE are both safe with ISLE being superior to CTE in gaining elongated length.

Serial Tissue Expansion at the Same Site in Pediatric Patients: Is the Subsequent Expansion Faster?

이문기,박성오,최태현 대한성형외과학회 2017 Archives of Plastic Surgery Vol.44 No.6

Background Serial tissue expansion is performed to remove giant congenital melanocytic nevi. However, there have been no studies comparing the expansion rate between the subsequent and preceding expansions. In this study, we analyzed the rate of expansion in accordance with the number of surgeries, expander location, expander size, and sex. Methods A retrospective analysis was performed in pediatric patients who underwent tissue expansion for giant congenital melanocytic nevi. We tested four factors that may influence the expansion rate: The number of surgeries, expander location, expander size, and sex. The rate of expansion was calculated by dividing the ‘inflation amount’ by the ‘expander size’. Results The expansion rate, compared with the first-time group, was 1.25 times higher in the second-or-more group (P=0.04) and 1.84 times higher in the third-or-more group (P<0.01). The expansion rate was higher at the trunk than at other sites (P<0.01). There was a tendency of lower expansion rate for larger expanders (P=0.03). Sex did not affect the expansion rate. Conclusions There was a positive correlation between the number of surgeries and the expansion rate, a positive correlation between the expander location and the expansion rate, and a negative correlation between the expander size and the expansion rate.

Serial Tissue Expansion at the Same Site in Pediatric Patients: Is the Subsequent Expansion Faster?

Lee, Moon Ki,Park, Seong Oh,Choi, Tae Hyun Korean Society of Plastic and Reconstructive Surge 2017 Archives of Plastic Surgery Vol.44 No.6

Background Serial tissue expansion is performed to remove giant congenital melanocytic nevi. However, there have been no studies comparing the expansion rate between the subsequent and preceding expansions. In this study, we analyzed the rate of expansion in accordance with the number of surgeries, expander location, expander size, and sex. Methods A retrospective analysis was performed in pediatric patients who underwent tissue expansion for giant congenital melanocytic nevi. We tested four factors that may influence the expansion rate: The number of surgeries, expander location, expander size, and sex. The rate of expansion was calculated by dividing the 'inflation amount' by the 'expander size'. Results The expansion rate, compared with the first-time group, was 1.25 times higher in the second-or-more group (P=0.04) and 1.84 times higher in the third-or-more group (P<0.01). The expansion rate was higher at the trunk than at other sites (P<0.01). There was a tendency of lower expansion rate for larger expanders (P=0.03). Sex did not affect the expansion rate. Conclusions There was a positive correlation between the number of surgeries and the expansion rate, a positive correlation between the expander location and the expansion rate, and a negative correlation between the expander size and the expansion rate.

자연스러운 목턱각 성형을 위한 안면부 조직확장술

이기응,고장휴,서동국,이종욱,최재구,장영철 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.5

Purposes: Wide scars occurring on the lower face and neck are a source of both functional and esthetic problems. Consequently, we can use skin grafts, pedicled flaps, free flaps, and tissue expansion for the reconstruction of this area. Compared with other reconstruction techniques, tissue expansion is advantageous in that it enables the maintenance of a color and texture similar to that of the adjacent tissue. However, the conventional method of tissue expansion has been reported to lead to an unnatural cervicomental angle and to the deformity of adjacent structures. We have therefore made efforts to prevent these problems through the use of several operative procedures. Methods: Forty-one patients with lower facial and cervical scars underwent tissue expansion. The tissue expansion was performed using a rectangular-shaped Nagosil® tissue expansion device. On insertion of the tissue expander, the intermediate area of superficial fat layer was dissected and then the tissue expander was inserted to make a flap that was as thin as possible. In advancement of the flap, a capsule—formed by the tissue expander—was used for the interrupted fixed suture of the flap to the fascia of the platysma muscle of the neck. This procedure was performed multiple times and also performed between the flap and the periosteum of the mandible, such that the tension was removed during the suture of the flap margin. Finally, the patients were fitted with a Jobst® facial garment in order to stabilize the operation site at least twelve months. Results: The most prevalent location of the scar was the cheek (15 cases), followed by the chin in 14 cases and the neck in 12 cases. The mean size of scar was 55.7 ± 39.4 ㎠. Conclusions: Using our procedures, we have experienced no significant deformities and have also achieved a more natural cervicomental angle in the patients.

Multifactorial analysis of the surgical outcomes of giant congenital melanocytic nevi: Single versus serial tissue expansion

Kim, Min Ji,Lee, Dong Hwan,Park, Dong Ha Korean Society of Plastic and Reconstructive Surge 2020 Archives of Plastic Surgery Vol.47 No.6

Background Giant congenital melanocytic nevus (GCMN) is a rare disease, for which complete surgical resection is recommended. However, the size of the lesions presents problems for the management of the condition. The most popular approach is to use a tissue expander; however, single-stage expansion in reconstructive surgery for GCMN cannot always address the entire defect. Few reports have compared tissue expansion techniques. The present study compared single and serial expansion to analyze the risk factors for complications and the surgical outcomes of the two techniques. Methods We retrospectively reviewed the medical charts of patients who underwent tissue expander reconstruction between March 2011 and July 2019. Serial expansion was indicated in cases of anatomically obvious defects after the first expansion, limited skin expansion with two more expander insertions, or capsular contracture after removal of the first expander. Results Fifty-five patients (88 cases) were analyzed, of whom 31 underwent serial expansion. The number of expanders inserted was higher in the serial-expansion group (P<0.001). The back and lower extremities were the most common locations for single and serial expansion, respectively (P =0.043). Multivariate analysis showed that sex (odds ratio [OR], 0.257; P=0.015), expander size (OR, 1.016; P=0.015), and inflation volume (OR, 0.987; P=0.015) were risk factors for complications. Conclusions Serial expansion is a good option for GCMN management. We demonstrated that large-sized expanders and large inflation volumes can lead to complications, and therefore require risk-reducing strategies. Nonetheless, serial expansion with proper management is appropriate for certain patients and can provide aesthetically satisfactory outcomes.

조직확장술을 이용한 광범위한 두피 탈모의 재건

양정민,정재호,설정현 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.5

Tissue expansion has been used for several decades in plastic and reconstructive surgery. Recently tissue expansion of the hair bearing scalp provides an excellent surgical option for the treatment of wide alopecia.During the period 1990 to 2001, 34 patients, 37 cases of wide alopecia with various causes were treated using tissue expansion. Choice of the size, shape, and the numbers of the expander was done by a senior author. The capsule of the expanded tissue remained intact and transposition flaps were use to redistribute expanded scalp. For three patients, serial expansion was performed to completely remove the remaining alopecia. Another patients with male pattern baldness were also successfully treated using tissue expansion technique.In conclusion, tissue expansion for alopecia is a simple, safe, and reliable method and provides excellent aesthetic results. It is the treatment of choice for wide alopecia due to burn, tumor excision, traffic accident and even for male pattern baldness.

One Stage Reconstruction of Skull Exposed by Burn Injury Using a Tissue Expansion Technique

Jae Young Cho,Young Chul Jang,Gi Yeun Hur,Jang Hyu Koh,서동국,Jong Wook Lee,Jai Koo Choi 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.2

Background An area of the skull exposed by burn injury has been covered by various methods including local flap, skin graft, or free flap surgery. Each method has disadvantages,such as postoperative alopecia or donor site morbidities. Due to the risk of osteomyelitis in the injured skull during the expansion period, tissue expansion was excluded from primary reconstruction. However, successful primary reconstruction was possible in burned skull by tissue expansion. Methods From January 2000 to 2011, tissue expansion surgery was performed on 10 patients who had sustained electrical burn injuries. In the 3 initial cases, removal of the injured part of the skull and a bone graft was performed. In the latter 7 cases, the injured skull tissue was preserved and covered with a scalp flap directly to obtain natural bone healing and bone remodeling. Results The mean age of patients was 49.9±12.2 years, with 8 male and 2 female. The size of the burn wound was an average of 119.6±36.7 cm2. The mean expansion duration was 65.5±5.6 days, and the inflation volume was an average of 615±197.6 mL. Mean defect size was 122.2±34.9 cm2. The complications including infection, hematoma, and the exposure of the expander were observed in 4 cases. Nonetheless, only 1 case required revision. Conclusions Successful coverage was performed by tissue expansion surgery in burned skull primarily and no secondary reconstruction was needed. Although the risks of osteomyelitis during the expansion period were present, constant coverage of the injured skull and active wound treatment helped successful primary reconstruction of burned skull by tissue expansion.

One Stage Reconstruction of Skull Exposed by Burn Injury Using a Tissue Expansion Technique

Cho, Jae-Young,Jang, Young-Chul,Hur, Gi-Yeun,Koh, Jang-Hyu,Seo, Dong-Kook,Lee, Jong-Wook,Choi, Jai-Koo Korean Society of Plastic and Reconstructive Surge 2012 Archives of Plastic Surgery Vol.39 No.2

Background : An area of the skull exposed by burn injury has been covered by various methods including local flap, skin graft, or free flap surgery. Each method has disadvantages, such as postoperative alopecia or donor site morbidities. Due to the risk of osteomyelitis in the injured skull during the expansion period, tissue expansion was excluded from primary reconstruction. However, successful primary reconstruction was possible in burned skull by tissue expansion. Methods : From January 2000 to 2011, tissue expansion surgery was performed on 10 patients who had sustained electrical burn injuries. In the 3 initial cases, removal of the injured part of the skull and a bone graft was performed. In the latter 7 cases, the injured skull tissue was preserved and covered with a scalp flap directly to obtain natural bone healing and bone remodeling. Results : The mean age of patients was $49.9{\pm}12.2$ years, with 8 male and 2 female. The size of the burn wound was an average of $119.6{\pm}36.7cm^2$. The mean expansion duration was $65.5{\pm}5.6$ days, and the inflation volume was an average of $615{\pm}197.6mL$. Mean defect size was $122.2{\pm}34.9cm^2$. The complications including infection, hematoma, and the exposure of the expander were observed in 4 cases. Nonetheless, only 1 case required revision. Conclusions : Successful coverage was performed by tissue expansion surgery in burned skull primarily and no secondary reconstruction was needed. Although the risks of osteomyelitis during the expansion period were present, constant coverage of the injured skull and active wound treatment helped successful primary reconstruction of burned skull by tissue expansion.

가토에서 강화된 신생혈관을 가진 이차적 근-피부피판에 대한 실험적 연구

한재식,김우경,김영조,이병일,한승규 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.2

There are occasions when standard techniques of reconstructive surgery for traumatic injury, tumor resection, and correction of congenital anomalies cannot be used as a result of the unavailability of tissues, absence of healthy vascular pedicle or excessive morbidity in donor area. It is established that autogenous skin, muscle, bone, and other composite tissue can retain their viability in varying degree as a prefabricated `flap with vascular pedicle implantation and the survival rate of these flaps has increased with tissue expansion or PGE₁ infusion. The purpose of this study was to demonstrate the reliability of the secondary or prefabricated rectus abdominis musculocutaneous flap, and to evaluate the effect of the several factors on the survival routes of these flaps. Fifty New Zealand white rabbits weighing from 250 to 350 gm were used for the study. On the abdominal area bipedicled skin flaps are elevated as a random pattern flaps and were prefabricated using with rectus muscle. The fifty flaps were studied. They were divided into the five groups as follows; group I, 10 ×4 cm classic axial pattern transverse rectus abdominis muscle (TRAM ) flaps were made as a control group (n = 10); groupⅡ, 10 ×4 cm random pattern bipedicled skin flaps were prefabricated using right rectus muscle with the delay procedure(n = 10); group III, 5 ×4 cm prefabricated musculocutaneous flap were made same as group II on the right, side, tissue expansion was performed on the left side (n = 10); group IV, same procedure was performed as group II, and in addition postoperative intravenous infusion of PGE?? was given(n = 10); group V, same procedure was performed as group III, and in addition postoperative intravenous infusion of PGE₁ and tissue expansion was performed(n = 10). Flap survival rates of each group were evaluated and compared. The following results were obtained: 1. Survival rates of prefabricated flaps were lower than that of classic axial pattern flaps regardless of using tissue expansion and PGE₁ infusion(p < 0.05). 2. In making a comparison between flap with and without PGE₁ infusion, survival rates of prefabricated flaps infused with PGE₁ were higher than that of flaps without PGE₁ infusion. 3. The prefabricated flaps managed with tissue expansion had higher survival rates than that of flaps without using tissue expansion. 4. The survival rates of prefabricated flaps managed in combination with tissue expansion and PGE₁ infusion were significantly higher than that of other groups except control group. In conclusion, this study demonstrated the significance of combiring use of tissue expansion and PGE₁ infusion in a prefabricated musculocutaneous flaps as a reliable method.