Tissue expansion
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Skin and tissue expander with inflatable balloon device. Source: NIH |
Tissue expansion is a technique used by
plastic and restorative
surgeons to cause the body to grow additional
skin,
bone or other tissues.
Keeping living tissues under tension causes new
cells to form and the amount of tissue to increase. In some cases, this may be accomplished by the implantation of inflatable balloons under the skin (see figure). By far the most common method, the surgeon inserts the balloon expander beneath the skin and periodically, over weeks or months, injects a
saline solution to slowly expand the overlaying skin. The growth of tissue is permanent.
1.
Breast reconstruction surgery, for example, can use this technique when the
mammary gland was removed by surgery (radical
mastectomy). Later a more permanent artificial implant (silicone
breast implant is inserted under the expanded pouch of skin.
In other applications, excess skin is grown purposely by expansion on the back or the buttocks, so that it can be harvested later for
transplantation to another site where skin was lost due to
trauma, extensive
wounds,
surgery,
burns, etc. A device called a
dermatome is used to slice thin strips of skin from the expanded area, which later is closed by suturing it.
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Skin expansion using a subcutaneous inflatable balloon. Source: NIH |
Tissue expansion has also been used for the technique of
foreskin restoration, which is usually non-surgical and applies tension externally using specialized devices to replace circumcised tissues with new cells. Nonsurgical techniques have also been used for breast enlargement.
Bone is another tissue that can be expanded relatively easily, by using external devices which are slowly separated using mechanical contraptions, so that bone grows in response to elongation (
bone distractor). Other techniques and external devices have been studied and have shown some success, such as in the
fitbone surgery.
3 This technique was pioneered in 1951 by the
Russian
physician Ilizarov, and is called the
Ilizarov apparatus. It is capable of lengthening limbs in cases of pathological loss of bone, asymmetry of limbs,
dwarfism, short stature, etc. In reconstructive and cosmetic surgery, bone expanders have been used to elongate the
mandibula in cases of
congenital disorders,
trauma,
tumors, etc. Other newer devices such as the
orthofix and
intramedullary skeletal kinetic distractor (ISKD) are also used for limb lengthening. It can add over 6 inches per bone, but is expensive, painful, and time-consuming (each procedure lasts around 8-12 months).
1. Neumann CG. The expansion of an area of skin by the progressive distension of a subcutaneous balloon.
Plastic Reconstructive Surgery 1957;19:124-30.
2. Radovan C.
Tissue expansion in soft-tissue reconstruction.
Plast Reconstr Surg 1984;74(4):482-92.
3.
External tissue expansion successfully achieved using negative pressure Zagazig University, Zagazig City, Sharkia, Egypt 2004
*
Ilizarov apparatus.
*
About Faces: Skin. NICDR National Institutes of Health on-line exhibit. Source of the images used.
