Excerpt from Skin, Tissue Expansion

Synonyms, Key Words, and Related Terms: reconstructive surgery, tissue expansion, skin expansion, tissue expander

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Tissue expansion has become a major reconstructive modality over the past 30 years. 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.

The lack of available soft tissues is a common challenge facing the reconstructive surgeon. The phenomenon of tissue expansion of the skin and underlying soft tissues has been observed commonly in pregnancy, slow-growing tumors, and fluid collections, where the local tissue expands and enlarges in response to the tension generated by the increased volume of the mass. This response has been found to be a metabolically active process with increased mitotic activity and vascularity of the expanded skin (Cherry, 1983) and has been applied clinically as an important skill in the armamentarium of the reconstructive surgeon.

In 1957, Neumann first used the principles of controlled tissue expansion in reconstructing an ear defect in which local skin was recruited using a subcutaneously placed rubber balloon (Neumann, 1957). This balloon was inflated gradually with air introduced through a polyethylene tube tunneled subcutaneously, exiting through a separate stab incision, and taped to the patient. An approximately 50% increase in surface area eventually was gained, providing adequate coverage for the reconstruction. However, not until the past 3 decades, beginning with Radovan’s description of a tissue expander in breast reconstruction in 1982, was interest in tissue expansion revived in reconstructive surgery. It is now an accepted standard technique providing a reliable and reproducible source of soft tissue to cover increasingly complex wounds.

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 (Austad, 1982; Pasyk, 1982). 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 (Anderson, 1993; Adson, 1987). In addition, expanded flaps are more resistant to bacterial invasion than random cutaneous flaps (Barker, 1987).

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