A special tissue expander in combination with extensive scalp-lifting

Brandy, Dominic A.

doi:10.1007/bf02273884

Cited by 12 publications

(3 citation statements)

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“…These results suggest that the factor driving pedicle skin expansion may be the mechanical stretch resulting from the rapid expansion of the underlying antlerogenic tissue. It has been shown that new skin is produced, in experimental condition, after stretching by subcutaneous insertion of an inflation‐controlled tissue expander (Austad et al, 1982; Brandy, 1991; Timmenga et al, 1989). Austad et al (1982) concluded that skin expansion is a physiological process to accommodate an enlarging mass beneath it by increasing surface area.…”

Section: Discussionmentioning

confidence: 99%

Histological studies of pedicle skin formation and its transformation to antler velvet in red deer (Cervus elaphus)

Suttie

2000

Anat. Rec.

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Deer antlers and their antecedent pedicles are made up of two components, interior osseocartilage and exterior integument. In a previous study, we described that histogenesis of the interior osseocartilage proceeds through four ossification stages. These are intramembranous (IMO), transition (OPC), pedicle endochondral (pECO), and antler endochondral (aECO). In the present study, we used histological techniques to examine pedicle skin formation and its transformation to antler velvet. The results showed that pedicle skin initiated from the apex of a frontal lateral crest and was formed through three distinctive stages. These stages are 1) compression of the subcutaneous loose connective tissue at the OPC stage, 2) stretching of the undulated epidermis at the early pECO stage, and 3) neogenesis of the skin and its associated appendages at the mid pECO stage. Transformation into antler velvet, which occurs at the late pECO stage, is mainly associated with alteration in the skin appendages. This alteration includes the loss of arrector pili muscle and sweat glands, and the gain of the large bi‐ or multi‐lobed sebaceous glands. These results suggest that pedicle skin expansion occurs to release the mechanical tension created by underlying forming antlerogenic tissue, initially in response to it by mechanical stretch, and then by neogenesis of skin. In turn, the stretched pedicle skin may exert mechanical pressure on the underlying antlerogenic tissue causing it to change in ossification type. Antler velvet generation may be accomplished by both mechanical stimulation and chemical induction from the underlying pECO stage antlerogenic tissue. If this hypothesis is correct it is likely that mechanical stimulation would drive skin formation and chemical induction then determine skin type. Furthermore, asynchronous transformation of the interior and exterior components during pedicle formation and antler generation may result from the delayed chemical induction and the way antler velvet initially generates. The results from both mitotic cell labelling of the basal layer and ultrastructure of the basement membrane of the apical skin in the study support these hypotheses. Anat Rec 260:62–71, 2000. © 2000 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

Histological studies of pedicle skin formation and its transformation to antler velvet in red deer (Cervus elaphus)

Suttie

2000

Anat. Rec.

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“…As described in other articles, 20,21 most extensively bald patients can be closed posteriorly with two extensive scalp‐lifting operations; namely, a bilateral occipitoparietal scalp‐lift and a bitemporal scalp‐lift 3 months later. Because the author 22 has proved statistically that approximately 60% of the stretching in extensive scalp‐lifting comes from the area inferior to the nuchal ridge (owing to lack of restrictive galea in that region), it can be calculated from that figure that approximately three extra operations would be needed to acquire closure.…”

Section: Design Conceptsmentioning

confidence: 99%

Circumferential Scalp Reduction

Brandy¹

1994

The Journal of Dermatologic Surgery and Oncology

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BACKGROUND. Conventional scalp reduction techniques involve the undermining of bald skin, inducing the problems of stretch-back and slot formation in the majority of patients. Conversely, extensive scalp-lifting, a relatively new technique, never undermines bald skin; therefore, the problem of stretch-back is minimal and slot formation is reduced. This procedure, however, is more intricate, owing to the undermining down to the hairline of the nape. Because not all cosmetic hair replacement surgeons desire to perform this more intricate surgery, the author takes many of the principles of scalp-lifting and applies them to the scalp reduction procedure. With the application of these principles, many of the problems of scalp reduction surgery are significantly reduced and other aesthetic aspects improved.

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“…Primary closure is possible after surgical excision of small or localized lesions, while larger lesions require more complicated reconstructive methods, such as tissue expansion applications, prior to excision. [5][6][7] In order to replace the hair-bearing scalp defect, the use of local tissue of similar quality and structure is optimal. For reconstruction of large lesions or defects, tissue expansion presents a useful option.…”

Section: Introductionmentioning

confidence: 99%

Aesthetic Reconstruction of Congenital Cerebriform Intradermal Nevus by Sequential Tissue Expansion at an Early Age: Ten-year Follow-up

Fırat¹,

Gürlek²,

Ayteki̇n³

et al. 2012

JIUMF

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Cerebriform intradermal nevus (CIN) is a congenital tumoral abnormality of the scalp. The incidence of development of malignant melanoma in CIN can rise up to 10%. Surgical excision of the lesion is the sole treatment modality for CIN. In this case, we present the 10-year follow-up of a 45-day-old infant with congenital CIN covering 75% of his scalp who had scalp reconstruction by sequential tissue expansion. Sequential tissue expansion processes with rectangular-shaped expanders of 450, 400, and 250 ml in size, respectively, were applied over an eight-month period. The interval between the two procedures was two weeks. The tissue expansion technique is a useful option for hair-bearing scalp reconstruction. This technique can be used sequentially or gradually. In order to obtain homogenous follicle distribution, the rest of the scalp should be expanded as much as possible. Careful planning in large defects helps prevent complications. In this case, we applied a sequential tissue expansion procedure when the patient was 45 days old, and the expansion period was continued for eight months. This very early age is a unique case for tissue expansion applications when compared with examples in the literature. On the other hand, we want to underline the aesthetic result of this case rather than the reconstructive method. Reconstruction of huge scalp defects by re-expansion (sequential expansion) and leaving the expander beneath the expanded flap until the sequential procedure decrease flap contracture reduces the required number of operations, and produces better aesthetic outcomes. Key Words: Cerebriform Intradermal Nevus; Tissue Expansion; Sequential Tissue Expansion. Ardışık Doku Genişletme İşlemi ile Konjenital Serebriform İntradermal Nevüsün Erken Yaşta Estetik Rekonstrüksiyonu: 0n Yıllık TakipSerebriform intradermal nevus skalpte görülen konjenital tümoral bir anomalidir. Malign melanoma gelişme insidansı %10'a kadar ulaşabilmektedir. Bu lezyon için cerrahi eksizyon tek tedavi seçeneğidir. Bu vakada, 45 günlük bir bebeğin kafa derisinin %75'ini kaplayan konjenital serebriform intradermal nevusün ardışık doku genişletme metodu ile tedavisinin 10 yıllık takip sonuçlarını sunmaktayız. Ardışık doku genişletme işlemi sırasıyla 450, 400, 250 ml'lik dikdörtgen şekilli doku genişleticilerle sekiz aylık bir sürede uygulandı. Sözkonusu bu üç doku genişletme işlemi arasındaki bekleme süresi 2 hafta idi. Doku genişletme tekniği saçlı deri rekonstrüksiyonunda oldukça etkin bir seçenektir. Bu teknik ardışık veya aşamalı olarak uygulanabilir. Homojen saç folikülü dağılımı elde etmek amacıyla, kalan saçlı deri elverdiği ölçüde genişletilebilir. Geniş defektlerin rekonstrüksiyonunda dikkatli planlama, komplikasyonların önlenmesinde yardımcıdır. Bu vakada, 45 günlük çocuk hastaya ardışık doku genişletme işlemini sekiz ay boyunca uyguladık. Bu vaka, literatürdeki diğer vakalarla kıyaslandığında bu kadar erken yaşta doku genişletici uygulanan tek vakadır. Diğer taraftan, rekonstrüksiyon metodundan ziyade on yıllık estetik sonucu vur...

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A special tissue expander in combination with extensive scalp-lifting

Cited by 12 publications

References 12 publications

Histological studies of pedicle skin formation and its transformation to antler velvet in red deer (Cervus elaphus)

Histological studies of pedicle skin formation and its transformation to antler velvet in red deer (Cervus elaphus)

Circumferential Scalp Reduction

Aesthetic Reconstruction of Congenital Cerebriform Intradermal Nevus by Sequential Tissue Expansion at an Early Age: Ten-year Follow-up

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