‘Expansion in-situ’ concept as a new technique for expanding skin and soft tissue

Abstract

Techniques for expanding skin and soft tissue are widely used to repair damaged areas since they facilitate the provision of new, additional skin tissue with similar quality, texture and color to that surrounding the defective area. Conventional expansion techniques involve placing expanders under the normal skin adjacent to a lesion. However, these techniques may involve additional incisions, complications with blood supply and ‘dog-ear’ deformities and may result in a low utilization rate of the expanded tissue. When reconstructing small defects that may not be sutured directly, these shortcomings, particularly the requirement to make additional incisions, limit the application of conventional techniques. The current study presents a novel approach to expansion called the ‘expansion in-situ’ technique. In this technique, the lesion is used as the center for expansion and expanders of optimal size are implanted under the lesion and surrounding normal soft tissue. Following expansion, the damaged area is excised directly. In order to avoid poor healing of the incision made during expander implantation, the overlapping suturing of both cut sides is conducted. This enlarges the contact area of both sides of the incision, thereby avoiding incision dehiscence and increasing wound healing during the expansion process. Between August 2006 and July 2011, the expansion in-situ technique was applied in 10 cases involving either nevus excision or scar removal. All 10 cases were treated successfully. Five of the cases were followed up over 1–3 years. The ‘expansion in-situ’ technique is likely to be useful for avoiding additional incisions and improving the utilization rate of expanded skin flaps.

Use of a chronic soft tissue expansion device to facilitate blepharoplasty in a horse with lower‐lid cicatricial ectropion with a 14‐year follow‐up

“…STED use facilitates wound closure by expanding tissue volume without altering tissue thickness or neuronal sensitivity, while containing similarly colored and textured skin sufficient enough to close both donor and recipient sites. 4 STEDs apply mechanical forces to the skin, which responds initially with the straightening and realignment of collagen fibers. Further elongation, past the skin's natural extensibility, results in displacement of water from collagen fibers and microfragmentation of elastic fibers, a mechanism termed "mechanical creep", which results in skin elongation.…”

Pre‐augmentation soft tissue expansion: an overview

“…Although the presence of scars might not be an “absolute” contraindication for expansion, it must be taken into consideration that compromised soft tissues usually have a lower expanding capacity compared to normal ones (Fang et al. ).…”

“…This phenomenon can be observed in abdominal skin during pregnancy, obesity, muscle growth or lip and neck expansion as a part of African traditions (Johnson et al 1993). Soft tissue expanders have the capability to enlarge soft tissue volumes without altering its thicknesses and to generate tissues with appropriate colour match and texture similar to that of the original tissues (Fang et al 2013). One of the clinical indica-tions of such technique is the preoperative expansion of the oral mucosa when large bone augmentations are planned.…”

“…On the contrary, skin expansion decreased the limiting effect of scar tissues on restriction of mid-facial growth (Edington et al 1998), implying the option of expanding compromised soft tissues. Although the presence of scars might not be an "absolute" contraindication for expansion, it must be taken into consideration that compromised soft tissues usually have a lower expanding capacity compared to normal ones (Fang et al 2013).…”

Evaluation of a new tension relief system for securing wound closure: A single-centre, Chinese cohort study

“…Two major techniques have been developed for solving such problems: skin and/or soft-tissue flap or graft; and skin and/or soft tissue elongation and expansion. Advantages of the expansion techniques include appropriate colour match, texture, sensibility, and substantial adnexa for aesthetic restoration of the resulting defect (1). However, conventional tissue expansion has been associated with a high complication rate, ranging as high as 40% to 50% (2).…”