Rapid intraoperative tissue expansion with Foley catheter in a challenging cripple Hypospadias

Failed hypospadiass cases may result in hypovascular, scarred penis with residual penile chordee and leave the patient with minimal residual skin for penile resurfacing and urethroplasty. Local tissue expansion has become a good alternative to provide skin for penis by using expanders however they require long periods of time for expansion. Besides, rapid tissue expansion was also described in different tissues. We used rapid intraoperative expansion technique by using a Foley catheter in a failed hypospadias case who had minimal residual skin secondary to infection and we concluded that rapid intraoperative tissue expansion with Foley catheter is an effective, feasible reconstructive method for easy dissection and penile resurfacing in failed hypospadiass cases.

Comparison of three skin-stretching devices for closing skin defects on the limbs of dogs

Our objective was to evaluate the effectiveness of skin-stretching devices for closing defects on the extremities of dogs. Antebrachial skin defects were created on the limbs of 24 dogs randomly divided into three groups. Skin stretchers included staples and sutures passing through them (group A), sutures and hypodermic needles (group B), and Pavletic device (group C). Wounds on the left were further undermined in all groups. Tension and blood perfusion were assessed. After removing the stretchers on day 3, the defects were sutured and wound healing was clinically scored. Histological variables evaluated were cellular infiltration, edema, collagen orientation, and thickness of epidermis. Significant differences in tension were found among groups (p < 0.0005) and between measurement times for undermined (p = 0.001) or non-undermined (p < 0.0005) wounds. In contrast, blood perfusion values did not differ significantly. Clinical scores for group B seemed to be better than those for groups A and C, but differences were not significant. Primary wound closure using the Pavletic device was not feasible. No significant differences in histological variables were found between groups. Skin stretching with staples or hypodermic needles resulted in successful wound management with minor side effects on skin histology and circulation.

Avaliação histológica e de espessura das cápsulas orgânicas formadas ao redor de expansores de tecidos de superfície lisa ou texturizada em humanos / Histological and wall thickness assessment of organic capsules formed around smooth and textured tissue expanders in humans", "_e": "n

INTRODUÇÃO: A busca por um produto que realize expansão tecidual com dano mínimo aos tecidos envolvidos, retalhos mais distensíveis e de menor espessura, e menos sintomas clínicos durante o processo de expansão tem levado as empresas a fabricar expansores com diferentes superfícies (lisa ou texturizada). A literatura é bastante controversa em relação às vantagens da utilização de um ou outro tipo. Esses aspectos motivaram os autores a pesquisar eventuais diferenças capsulares que pudessem justificar a escolha clínica. MÉTODO: Foi realizado um estudo cego, prospectivo, sem critérios de exclusão, em 38 pacientes submetidos a expansão tecidual no Serviço de Cirurgia Plástica do Hospital Universitário da Universidade Federal do Rio de Janeiro (Rio de Janeiro, RJ, Brasil). Ao final do processo de expansão, foram coletados fragmentos da periferia, da base e da cúpula das cápsulas de 28 expansores de superfície lisa e de 14 de superfície texturizada, para estudo da espessura e de possíveis diferenças histológicas. RESULTADOS: Não houve diferenças entre os dois tipos de expansor quanto aos aspectos clínicos, ao tempo efetivo de expansão e aos planos de inclusão. Na avaliação dos parâmetros histológicos, não foram observados valores significativamente diferentes segundo a superfície do expansor. Não houve correlação entre espessura e tempo de permanência, e a diferença entre as espessuras máxima e mínima foi considerada igual para os dois tipos de superfície. CONCLUSÕES: Não há diferenças significativas do ponto de vista histológico, nem razões clínicas, que indiquem vantagens de um ou outro tipo de expansor no processo de expansão tecidual.

BACKGROUND: The search for an expander that can achieve tissue expansion, with minimum tissue damage, more distensible and thinner flaps, and fewer clinical side effects during the expansion process, has led to the testing of expanders with different surfaces textures (e.g., smooth vs. textured). The individual advantages of smooth and rough expanders are currently not known. This question has motivated research on capsules to determine which type of expander is best. METHODS: We conducted a double-blind, prospective study with no exclusion criteria on 38 patients already undergoing tissue expansion at Plastic Surgery Department at the Universidade Federal do Rio de Janeiro (University Hospital of the Federal University of Rio de Janeiro). At the end of the expansion process, samples were collected from the edge, base, and dome of capsules formed around 28 smooth and 14 textured expanders. Differences in capsule wall thickness and histology were examined. RESULTS: There was no difference in the clinical appearance, expansion time, or insertion planes between the two types of expanders. Additionally, no significant differences in histological characteristics were observed between the types of expander surfaces. In statistical analyses, no correlation between capsule wall thickness and expansion time or between the maximum and minimum wall thickness were observed. CONCLUSIONS: Therefore, we conclude that the two types of tissue expander surfaces are equivalent.

Asociación de malla de polipropileno y expansores tisulares en la reconstrucción de pared abdominal / Association of polypropylene mesh and tissue expanders in the abdominal wall reconstruction

La reconstrucción de grandes defectos de la pared abdominal, no factible de cierre primario continúa siendo un desafío quirúrgico. La utilización de expansores tisulares en asociación con malla de polipropileno constituye una excelente alternativa, con innegables ventajas sobre las demás técnicas descritas en la literatura

Principios básicos de la expansión cutánea / Basic principles of the cutaneous expansion

Los expansores cutáneos representan una valiosa herramienta terapéutica en cirugía plástica reconstructiva. Esta técnica permite obtener una cobertura cutánea de color y textura similar a la piel adyacente, con mínima morbilidad del sitio dador. Sin embargo, es un procedimiento que debe realizarse en etapas y no está exento de complicaciones. Estas pueden minimizarse mediante una meticulosa planificación y ejecución, única forma en que la calidad de los resultados justifiquen su empleo. Se analizan las bases fisiológicas, tipos de expansores, indicaciones, principios generales y complicaciones de la técnica

Expansión cutánea transoperatoria / Cutaneous intraoperative expansion

Se trataron 15 pacientes entre 4 y 88 años de edad con el método de expanción cutánea transoperatoria, como adyuvante para lograr el cierre directo complejo de amplios defectos quirúrgicos resultantes de la extirpación de diversas lesiones cutáneas. Se utilizaron sondas de Foley como expansores. El expansor se coloca a uno o a ambos lados del defecto, se realizan varios ciclos de expansión para lograr la distensión de la piel vecina al defecto y con la piel distendida se procede al cierre de la herida quirúrgica. En el 70 por ciento de nuestros casos el resultado cosmético fue considerado excelente. El volumen medio de llenado por ciclo necesario para lograr la distención cutánea adecuada fue de 18.3 cc. En todos los pacientes se logró el cierre directo de la herida quirúrgica, por lo que concluimos que la expansión cutánea transoperatoria es un método eficaz para lograr el cierre directo de heridas quirúrgicas en la resección de amplias lesiones cutáneas