Tissue expansion in pediatric patients

Rivera, Roxana; LoGiudice, John; Gosain, Arun K.

doi:10.1016/j.cps.2004.08.001

Cited by 70 publications

(68 citation statements)

References 49 publications

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“…After several weeks, the expanders are removed, the nevus is excised, and the defect area is covered with the newly grown skin, right [10]. One preeminent advantage of this technique is the production of skin with the same hair, mechanical properties, color and texture of the surrounding tissue, making it ideal from an aesthetic point of view [47]. At the same time, tissue expansion remains challenging, several open questions prevail, and surgeons have to rely on their own decade-long experience to successfully plan and execute this technique[5].…”

Section: Introductionmentioning

confidence: 99%

Multi-view stereo analysis reveals anisotropy of prestrain, deformation, and growth in living skin

Tepole

Gart

Purnell

et al. 2015

Biomech Model Mechanobiol

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Skin expansion delivers newly grown skin that maintains histological and mechanical features of the original tissue. Although it is the gold standard for cutaneous defect correction today, the underlying mechanisms remain poorly understood. Here we present a novel technique to quantify anisotropic prestrain, deformation, and growth in a porcine skin expansion model. Building on our recently proposed method, we combine two novel technologies, multi-view stereo and isogeometric analysis, to characterize skin kinematics: Upon explantation, a unit square retracts ex vivo to a square of average dimensions of 0.83 × 0.83. Upon expansion, the unit square deforms in vivo into a rectangle of average dimensions of 1.40 × 1.34. Deformations are larger parallel than perpendicular to the dorsal midline suggesting that skin responds anisotropically with smaller deformations along the skin tension lines. Upon expansion, the patch grows in vivo by 1.62 × 1.40 with respect to the explanted, unexpanded state. Growth is larger parallel than perpendicular to the midline, suggesting that elevated stretch activates mechanotransduction pathways to stimulate tissue growth. The proposed method provides a powerful tool to characterize the kinematics of living skin. Our results shed light on the mechanobiology of skin and help us to better understand and optimize clinically relevant procedures in plastic and reconstructive surgery.

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Section: Introductionmentioning

confidence: 99%

Multi-view stereo analysis reveals anisotropy of prestrain, deformation, and growth in living skin

Tepole

Gart

Purnell

et al. 2015

Biomech Model Mechanobiol

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“…Asymmetry noted during breast development is best managed with an intermediate tissue expander until full breast development is complete, after which exchange to a permanent breast prosthesis can be performed. 75 Some lesions of the trunk are so extensive that there is inadequate regional tissue to make expansion a practical method of reconstruction. In these cases, we have used tissue expansion if this can serve to decrease visibility of the nevus in areas more visible in clothing (e.g., the upper back and chest and/or the thighs in a bathing trunk nevus) (Figs.…”

Section: Treatment Of Specific Anatomical Sites Trunkmentioning

confidence: 99%

“…Giant nevi of the cheek can be addressed with expanded cervical flaps, with the possible addition of expanded postauricular flaps if additional tissue is needed. 75 Expanded full-thickness skin grafts are the best option for the periocular and eyelid regions, generally from the supraclavicular region, to ensure proper color match. A giant nevus affecting multiple aesthetic subunits of the nose is best treated with an expanded forehead flap.…”

Section: Scalp and Facementioning

confidence: 99%

Giant Congenital Melanocytic Nevi

Arneja

Gosain

2007

Plastic and Reconstructive Surgery

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“…Since then, skin expansion has been eagerly adopted by clinicians and has revolutionized the field of plastic and reconstructive surgery. Skin expansion creates new skin with the same mechanical, hair bearing, color, and texture characteristics as the surrounding tissue, which is ideal from an aesthetic point of view [52]. …”

Section: Motivationmentioning

confidence: 99%

Computational modeling of skin: Using stress profiles as predictor for tissue necrosis in reconstructive surgery

Tepole

Gosain

Kuhl

2014

Computers & Structures

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Local skin flaps have revolutionized reconstructive surgery. Mechanical loading is critical for flap survival: Excessive tissue tension reduces blood supply and induces tissue necrosis. However, skin flaps have never been analyzed mechanically. Here we explore the stress profiles of two common flap designs, direct advancement flaps and double back-cut flaps. Our simulations predict a direct correlation between regions of maximum stress and tissue necrosis. This suggests that elevated stress could serve as predictor for flap failure. Our model is a promising step towards computer-guided reconstructive surgery with the goal to minimize stress, accelerate healing, minimize scarring, and optimize tissue use.

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Tissue expansion in pediatric patients

Cited by 70 publications

References 49 publications

Multi-view stereo analysis reveals anisotropy of prestrain, deformation, and growth in living skin

Multi-view stereo analysis reveals anisotropy of prestrain, deformation, and growth in living skin

Giant Congenital Melanocytic Nevi

Computational modeling of skin: Using stress profiles as predictor for tissue necrosis in reconstructive surgery

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