Quantitative benefits provided by acute tissue expansion: a biomechanical study in human cadavers

Raposio, Edoardo; Cella, A.; Panarese, Paola; Caregnato, P.; Gualdi, Alessandro; Santi, Pier Luigi

doi:10.1054/bjps.1999.3222

Cited by 10 publications

(3 citation statements)

References 18 publications

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“…Mainly owing to the presence of the galea aponeurotica, the mean stiffness of a scalp flap is approximately three to four times the mean stiffness of a cutaneous flap elevated on either the abdomen or the dorsum of the hand. [ 18 19 ] Acute scalp expansion is ineffective probably because the inelasticity of the galea aponeurotica does not allow expansion of the elastic overlying scalp skin through the effect of mechanical creep. A clinical study evaluating if and to what extent galeotomies might affect the acute expansion of a scalp flap would be useful since, at present, no data are available to support this hypothesis.…”

Section: Methods and Resultsmentioning

confidence: 99%

Scalp expansion: Surgical considerations and possible future directions

Raposio

2018

Indian J Plast Surg

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Introduction:Repairing large scalp defects has always been a difficult task for plastic surgeons. This is because the requirements of such procedures are two-fold: sufficient soft-tissue coverage is required, and to obtain a satisfactory aesthetic outcome, a sufficient number of covering hairs should be ideally provided.Materials and Methods:Based on the author's experience in this repair technique over a 20-year period, this article presents some technical details of scalp expansion, surgical refinements and possible directions for further technical advancement.Results:Data and details on relevant scalp anatomy, expander choice, expander placement, subgaleal undermining, galeotomies and acute scalp expansion are provided.Conclusions:The author hopes that the above-mentioned details may be of some utility in the complex field of scalp expansion.

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Section: Methods and Resultsmentioning

confidence: 99%

Scalp expansion: Surgical considerations and possible future directions

Raposio

2018

Indian J Plast Surg

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“…We believe that DynaClose tapes produce mechanical creep in the treatment arm which translates to decreased tension in wound closure [14] and increased rate of primary closure with or without a small full thickness skin graft [7]. Our hypothesis was that there would be an observable change in pliability, measured here as an increased vertical deformation under a given suction load.…”

Section: Discussionmentioning

confidence: 99%

The effect of topically applied tissue expanders on radial forearm skin pliability: A prospective self-controlled study

Chung

Bonaparte

Odell

et al. 2014

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundThe use of pre-operatively applied topical tissue expansion tapes have previously demonstrated increased rates of primary closure of radial forearm free flap donor sites. This is associated with a reduced cost of care as well as improved cosmetic appearance of the donor site. Unfortunately, little is known about the biomechanical changes these tapes cause in the forearm skin. This study tested the hypothesis that the use of topically applied tissue expansion tapes will result in an increase in forearm skin pliability in patients undergoing radial forearm free flap surgery.MethodsTwenty-four patients scheduled for head and neck surgery requiring a radial forearm free flap were enrolled in this prospective self-controlled observational study. DynaClose tissue expansion tapes (registered Canica Design Inc, Almonte, Canada) were applied across the forearm one week pre-operatively. Immediately prior to surgery, the skin pliability of the dorsal and volar forearm sites were measured with the Cutometer MPA 580 (registered Courage-Khazaka Electronic GmbH, Cologne, Germany) on both the treatment and contralateral (control) arms. Paired t-tests were used to compare treatment to control at both sites, with p < 0.025 defined as statistically significant.ResultsThere was a statistically significant increase in pliability by a mean of 0.05 mm (SD = 0.09 mm) between treatment and control arms on the dorsal site (95% CI [0.01, 0.08], p = 0.018). This corresponded to an 8% increase in pliability. In contrast, the volar site did not show a statistically significant difference between treatment and control (mean difference = 0.04 mm, SD = 0.20 mm, 95% CI [−0.04, 0.12], p = 0.30).ConclusionsThis result provides evidence that the pre-operative application of topical tissue expansion tapes produces measurable changes in skin biomechanical properties. The location of this change on the dorsal forearm is consistent with the method of tape application. While this increase in skin pliability may account for the improved rate of primary donor site closure reported using this technique, the results did not reach our definition of clinical significance.

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“…3 In fact, force distribution dynamometers have been previously used in the context of plastic surgery. 4 In addition, the use of force evaluation could be further expanded to evaluate the efficiency of other surgical techniques because it enables quantitative measurements of results in comparison to the subjective evaluation made by patients themselves, which has major limitations. 2,3,5 After validating the procedure on cadavers, the authors have successfully tested the validity of the tool also in patients.…”

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confidence: 99%