Prolonged Standard Tissue Expansiono

Prolonged tissue expansion is commonly used for scalp, nasal, and ear reconstruction, and for skin replacement in the forehead, cheek, and neck. Expansion of the

forehead flap with a rectangular tissue expander (250 ml) allows primary closure of the donor site and additional tissue for near-total or total nasal reconstruction. The expander is placed submuscularly (subgaleal) and is expanded over 8-10 weeks. Expansion of the postauricular skin for microtia repair can be done; however, risk of implant exposure, infection, and thickened flaps is a potential drawback to its use. Tissue expansion for skin replacement in the forehead, cheek, and neck is valuable since the expanded skin is adjacent to the defect and, in most cases, is almost identical to the missing or damaged skin (Fig. 5). Perhaps the most popular application in the head and neck is for defects of the scalp since hair-bearing skin is required

Expanded tissue arises from two sources: recruitment from adjacent tissue and altered histological nature of the overlying skin. The histological skin changes result from mechanical creep and biological creep (52). Mechanical creep refers to the ability of skin to stretch beyond its inherent extensibility through water and ground substance displacement, elastic fiber fragmentation, realignment of the collage fibers, and adjacent tissue migration. Biological creep refers to an increase in tissue volume »

through proliferation of epithelial cells, increased epidermal mitotic activity, expansion of the subdermal vascular network, and increased synthesis of collagen by fibro- ^ blasts.

The technique of prolonged tissue expansion involves placement of the expander adjacent to the defect through an incision at the edge of the defect or in a hidden area such as the hairline, except if the defect is covered with a skin graft. However, placement of access incisions at or near the junction of the defect ©

and the adjacent skin to be expanded leads to higher rates of expander exposure and premature removal (48). Placement is usually in the subcutaneous plane in the face, under the platysma for neck expansion (avoiding placement over vital vascular structures), or under the galea for scalp expansion. Placement of deep permanent sutures may decrease the incidence of implant exposure (48). Slight initial expansion is helpful to eliminate dead space, but definitive (weekly) expansions should be delayed for at least 2 weeks postoperatively. The amount of saline injected should be gauged by changes in the overlying skin (tension or pallor). The overlying skin should retain capillary refill after expansion. An interval capsu-lotomy is occasionally necessary if expansion is arrested prematurely due to an overly dense capsule. The expander may leak slightly after placement, however, expansion should proceed if possible.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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