The influence of self-inflating soft tissue expander on the outcomes of horizontal alveolar ridge augmentation: A randomized controlled clinical and histological study.

OBJECTIVE: The present study was conducted to evaluate the effect of soft tissue augmentation using a self-inflating soft tissue expander when performed before horizontal alveolar ridge augmentation on the outcomes of the bone augmentation procedure. The primary outcome is the bucco-palatal radiographical changes in alveolar ridge width, while the secondary outcome is the quality of the augmented bone assessed histomorphometrically. MATERIALS AND METHODS: Sixteen patients underwent horizontal alveolar ridge augmentation using autogenous bone. For the test group, soft tissue expanders were used in a separate surgery before bone grafting surgery. For the control group, patients received treatment including single surgery of bone grafting associated with periosteal releasing incision. Implants were placed in both groups 6 months after bone augmentation. Bucco-palatal changes in alveolar ridge width were evaluated via cone-beam computed tomography. Augmented bone quality was assessed histomorphometrically. RESULTS: After 6 months, regarding radiographic bone width, there was no statistically significant difference between the two groups, as mean bone width in group I and group II were 8.57 mm and 8.75 mm, respectively. Regarding histomorphometric analysis, Group I showed significantly higher mean bone surface area fraction, higher median mature collagen area fraction, and higher median blood vessel count than Group II (p-value = .012), (p-value = .004), and (p-value = .014), respectively. CONCLUSION: Within the limitations of the present study, soft tissue expander has no influence on bone width gain after horizontal alveolar ridge augmentation with an autogenous bone block but may have a positive effect on the quality of augmented bone.

Establishment of a Novel Mouse Model for Soft Tissue Expansion.

BACKGROUND: Despite its increasing use, not much is known about tissue expansion, and its complication rates are significantly high. Thus, there is an urgent need to establish a stable animal model to overcome the limitations and complications of tissue expansion. Although the mouse model has shown several advantages in the in-depth studies, an appropriate mouse expansion model has rarely been reported, likely because of its loose skin. MATERIALS AND METHODS: A micro expander was designed and implanted under the scalp of a mouse (expanded group); sterilized saline was regularly injected into the expander. In sham-operated mice (control group), a silicone sheet was implanted under the scalp. Skin samples were collected 5 wk after surgery. Histologic changes including epidermal and dermal thickness and collagen fiber arrangement were analyzed. In addition, vascular density and cell proliferation ratio were determined. An ultrastructural analysis was also performed. RESULTS: With the application of the expansion device, the skin became tight and showed area enlargement. The epidermal thickness of the expanded skin increased significantly (P < 0.01), whereas the thickness of the dermis decreased significantly (P < 0.05) as compared with the control skin. Masson staining demonstrated that collagen bundles were arranged more compactly in the expanded skin (P < 0.05) than in the controls. Furthermore, more proliferating cells (P < 0.05) and blood vessels (P < 0.01) were observed. Transmission electron microscopy showed that the fibers of expanded skin were stretched and broken into bundles of various diameters, with abundant active fibroblasts. CONCLUSIONS: A reliable mouse model of scalp skin expansion was successfully established, which may be a promising tool for in-depth studies on skin soft tissue expansion.

Analysis of clinical efficacy in using expanded retroauricular flap to fully cover reconstructed cartilage scaffold / 中华整形外科杂志

Objective@#In order to achieve superior aesthetic outcomes of reconstructed ear, analyze and summarize clinical therapeutic effect in completely applying expanded retroauricular flap to encapsulate cartilage scaffold in total auricular reconstruction.@*Methods@#From January 2016 to October 2017, fifty-three congenital microtia patients were treated. A kidney-shaped tissue expander with 50 ml capacity was embedded under retroauricular skin in the first-stage. After excessive expansion to 70 ml and remaining stable for 4 weeks, secondary operation was performed to completely encapsulate cartilage scaffold with expanded retroauricular skin. Postoperative follow-up was carried out on a routine basis.@*Results@#All patients had undergone operations successfully with primary healing of incision. Blood supply of the retroauricular flaps was excellent, and cartilage scaffolds totally survived with no infection and absorption. Satisfactory aesthetic outcome along with clear structure, reasonable symmetry and suitable auriculocephalic angle was acquired in all cases. No color aberration was observed between the front and back side of reconstructed ear. Scars of retroauricular incisions and costal cartilage harvesting incisions were unconspicuous.@*Conclusions@#Only using expansive retroauricular flap to fully cover reconstructed cartilage scaffold is reasonable and simple without skin grafting, which is worthy of more application in microtia treatment.

Clinical experience and analysis on the complications of the one-stage surgery with prolonged tissue expansion in microtia reconstruction / 中华整形外科杂志

Objective@#To explore procedure of the one-stage surgery with prolonged tissue expansion in microtia reconstruction and treatment of related complications.@*Methods@#211 patients had undergone the one-stage surgery of microtia reconstruction with prolonged tissue expansion in Department of Aesthetic Plastic and Maxillofacial Surgery, the First Affiliated Hospital of Xi′an Jiaotong University from June 2016 to June 2017. A retrospective study of these data was conducted for standardization of surgical procedure, treatment of postoperative complications, improvement of the existing technology.@*Results@#211 patients had finished the follow-up, of which 10 had complications. The complications included 4 cases of hematomas, 3 cases of expander exposures, 2 infections, and disorder on blood supply of the flap with severe headache in 1 case. We removed hematoma by washing and drainage, repositioned the exposed expander by standard debridement surgery again, controlled infection by systemic or topical application of effective antibiotics, andrelieved severe headache by reducing injection volume. After these treatments, all the patients were able to undergo the next stage surgery of ear reconstruction.@*Conclusions@#Emphasizing standardization of surgical procedure, appropriate treatment of postoperative complications and improvement of tissue expansion was beneficial for performing the next stage surgery of ear reconstruction.

Frontal and scalp expanded skin flap combined with laser hair removal for children congenital facial giant nevi / 中华整形外科杂志

Objective@#To investigate the feasibility and therapeutic effect of frontal and scalp expanded skin flap combined with laser hair removal for children congenital facial giant nevi.@*Methods@#From January 2013 to December 2015, 6 cases with congenital facial giant nevi were treated with expanded frontal and scalp skin flap combined with laser hair removal in the department of plastic surgery, An Zhen Hospital, Capital Medical University. The process of treatment could be divided into three stages. Stage 1: The expander capacity was determined according to the size of lesion. Expander was implanted under the galea aponeurotica in front and scalp, and expanded regularly postoperatively. Stage 2: The expander was removed and facial giant nevi was excised. The expanded skin flap was designed according to the shape and size of nevi. Stage 3: After the expanded skin flap healed completely, laser hair removal was performed for 4-6 times with 6 weeks of interval time.@*Results@#300 ml to 350 ml expanders were selected with expanding frequency of 2 times a week. The expansion time lasted for 16 to 20 weeks(average, 18.7 weeks). The complications such as leakage, angle and skin flap blood supply obstacle didn't occurr in the process of expansion. The size of frontal and scalp skin flap ranged from 12 cm×11 cm to 20 cm×17 cm. Venous drainage disorder happened in one flap and was treated by partial suture removal and acupuncture bleeding treatment. Skin flap necrosis didn't occurred. The defects at donor sites were sutured directly with inconspicious scar. The effect of semiconductor laser hair removal was good without recurrence during one-year follow-up period. All expanded skin flaps had no obvious contraction with good match of color and texture.@*Conclusions@#This method provides a new selection of donor site for larger facial defect with reliable effet. The facial giant nevi could be excised completely and repaired in one operation with short operation time. The scar in middle face and secondary deformities can be avoided.

A case-control study on infection following skin and soft tissue expander implantation / 中国感染控制杂志

Objective To analyze the risk factors of postoperative infection in patients with skin and soft tissue ex-pander (SSTE)implantation,and provide scientific evidence for making intervention strategies.Methods Question-naires were made,relevant data were obtained through medical record reviewing and telephone inquiry,and case-control method was used to conduct statistical analysis.Results A total of 532 patients were with SSTE implanta-tion,22 (4.14%)of whom had infection,and 14 infected patients were included in this research.Univariate logistic regression analysis indicated that there were significant difference in the number of the embedded expanders (OR=1 .58,95%CI :1 .20-2.32),the implantation site(OR =1 .75,95%CI :1 .30 -2.32),living circumstances of pa-tients(OR=1 .87,95%CI :1 .84 -2.65 ),and whether expanders were regularly disinfected(OR =2.66,95%CI :1 .76-4.32)(all P <0.05).Multivariate logistic regression analysis found that living circumstances of patients(OR=1 .55,95%CI :1 .15-2.25)and whether expanders were regularly disinfected (OR=3.66,95%CI :2.86-3.22) were two main factors entering the regression equation(both P <0.01 ).Conclusion Living circumstances of pa-tients and whether expanders are regularly disinfected are main risk factors of postoperative infection in patients with SSTE embedding.Knowledge education on preventing infection among patients and main caregivers should be strengthened,post-discharge continuous nursing system should be established.

Perioperative nursing of patients with planted soft tissue expander after breast cancer surgery / 现代临床护理

Objective To explore the key points of perioperative nursing patients with planted soft tissue expander after breast cancer surgery.Method The clinical data of 55 patients with planted soft tissue expander after breast cancer surgery were reviewed to summarize the nursing measures.Result Operative process in 55 pattents were succesful,surgery time ranged from 3 to 5 hours.16 of 55 patients developed with complications and all of them were recovered and discharged.Conclusions Perioperative nursing intervention for the patients with planted soft tissue expander after breast cancer surgery can reduce the incidence of complications,improve the life quality and help them build up their confidence in social and family life.