经瘢痕内与扩张区主轴垂直小切口埋置扩张器行快速扩张术

目的：研究合适快速组织扩张术的扩张器置入方法。方法：选用定制的薄壁长管无注射壶扩张器，对45例皮肤瘢痕患者，在局部肿胀麻醉下经瘢痕内与扩张区主轴垂直小切口埋置扩张器，注水导管外置，术中大量注水扩张，术后进行3种方式的快速扩张。结果；在局部肿胀麻醉下，皮下间隙制作均获成功。术中出血少，所有患者均未输血。45例在快速扩张中无切口感染和裂开并发症。结论：经瘢痕内与扩张区主轴垂直小切口埋置扩张器损伤小，安全性高，适合进行各种快速皮肤扩张。     

导管外置式扩张器及其临床应用评价

目的；研制安全可靠的新型扩张器，控制扩张器相关并发症的发生。方法：设计并制作导管外置式薄壁硅胶扩张器，进行快速皮肤扩张应用观察。结果：新型扩张器质软，弹性好，可经微创切口埋入皮下间隙，体外注水扩张和管理极为方便。临床应用362个部位，均顺利完成快速扩张，扩张器相关并发症发生率为3．59％。结论：导管外置式扩张器使用简单，手术损伤小，适合快速，皮肤扩张使用，可控制扩张器相关并发症。     

小切口和皮下减张缝合技术在皮肤软组织扩张器置入术中的应用

目的：介绍小切口和皮下减张缝合技术在皮肤软组织扩张器置入术中的应用,以探寻更符合美学要求的软组织扩张整形美容技术。方法：根据瘢痕类型选用不同型号及形状的可控型扩张器,在局部肿胀麻醉下,经1.0～2.0cm小切口埋置扩张器。冷光源照射下,直视止血,切口皮下做减张缝合,术中注水10%～100%,切口7～10天拆线。结果：236例患者,507个扩张部位手术均获得成功。术后切口裂开3例（0.6%）,发生血肿11例（2.2%）,平均埋置一个扩张器的时间为45min,平均注水时间12周。手术时间和注水时间比常规方法缩短。结论：扩张器置入手术时应用小切口和皮下减张缝合技术具有损伤小,并发症发生率低,手术时间及注水时间缩短等优点,值得推广。     

微创技术在皮肤扩张术中的应用

目的探讨微创技术在皮肤扩张术中的应用效果. 方法在局部肿胀麻醉下,运用自制的套管剥离和置入器械,经微小切口将超薄型扩张器置入皮下腔隙中,行皮肤扩张术20例(观察组).将传统手术切开法置入扩张器的10例患者作为对照组. 结果全部病例临床疗效满意,观察组和对照组完成扩张注液平均周期分别为(26.5±3)d和(68.5±7)d,两组比较有显著差异(P<0.01).术后并发症发生率分别是5%和20%,两组有显著性差异(P<0.05). 结论经微创切口埋置扩张器,损伤小,扩张周期短,并发症少,值得推广.     

微创法超薄皮瓣式皮肤扩张法在面颈部瘢痕治疗中的应用

研究探索一种高效的面颈部皮肤扩张方法。方法：选用长导管薄壁扩张器，经微创切口作潜行超薄皮瓣式皮下间隙剥离并埋入扩张器，术后2～3天进行快速扩张，完成扩张后制作超薄扩张后皮瓣修复瘢痕切除后创面。结果：42例共117个扩张部位均顺利完成注水扩张，Ⅱ期手术的超薄扩张后皮瓣回缩率低、回缩力小，修复术后面部表面平坦，颌颈角正常。发生血肿、炎症．皮瓣部分环死、扩张器外露共9个部位，经治疗全部得到控制，总并发症发生率为7．7％。结论：超薄皮瓣式皮肤扩张法用于面颈部瘢痕治疗效果优良，美学效果好，并发症少。     

持续注水快速皮肤软组织扩张术的临床应用

目的　探讨一种简单易行的持续快速皮肤扩张方法及其临床应用。方法　选择 2 2例瘢痕、色素痣及毛细血管瘤患者 ,Ⅰ期手术在病变内设计垂直小切口埋置扩张器 ,术后第 2天开始用微量推注泵做持续注水扩张。注水结束后 3～ 5d行Ⅱ期手术。结果　共埋置扩张器 35个 ,选择灌注速度为每10 0ml扩张器容量 0 .2～ 0 .8ml/h进行持续注水扩张。平均注水时间 15 .3d ,1例出现切口处扩张器外露 ,1例于Ⅱ期术后出现皮瓣远端部分坏死。经 3个月至 1年的随访 ,效果较满意。结论　采用病变内垂直小切口埋入扩张器 ,并早期应用微量推注泵做持续注水扩张 ,可以最大限度地缩短扩张期时间 ,是一种较理想的快速皮肤扩张法。     

皮肤扩张术37例临床应用体会

目的:探讨皮肤软组织扩张术并发症的预防措施。方法:利用皮肤软组织扩张技术一期埋置61个皮肤软组织扩张器,对37例患者进行修复重建,总结预防扩张术并发症的部分经验。结果:37例61只扩张器1只发生外露,1只发生血肿。结论:皮肤软组织扩张术并发症的发生与术者对局部解剖熟悉程度、操作技巧、切口选择、注水时间以及患者的一般情况等有密切的关系。     

快速组织扩张术在皮肤软组织缺损修复中的应用

目的 探讨采用皮肤快速扩张术修复创伤性皮肤软组织缺损的方法和效果.方法 选择19例外伤性皮肤软组织缺损患者,共19个创面,择期埋置37个皮肤扩张器并进行快速扩张.术后第5天开始,隔日注水扩张1次,每次注水至有局部有轻度胀感.完成扩张后制作皮瓣,修复外伤性皮肤缺损创面,分Ⅲ期手术完成.结果 37个扩张器全部完成注水扩张过程,注水扩张时间为46～63 d.有5个扩张区出现并发症,但均得到控制.19个缺损创面均得到完整修复.6个月后随防1 2例,皮瓣色泽和质地与受区皮肤接近,外观良好,局部无臃肿.结论 快速皮肤扩张术是修复某些特殊部位创伤性皮肤缺损的可行有效方法,可获得功能和美学双重修复的满意结果.     

早期快速扩张法在体表瘢痕修复中的应用

目的 探讨皮肤软组织早期快速扩张法在体表瘢痕修复中的应用效果.方法 行垂直小切口埋置扩张器,采用术中注入扩张器容量30%和术后每天注人约扩张器容量10%的快速扩张方法扩张皮肤,用滑行皮瓣,旋转皮瓣等修复瘢痕缺损.结果 21例患者共埋置扩张器47个,平均扩张时间17.2d,疼痛不明显,一次性修复皮肤缺损区域,扩张皮瓣全部存活.经过3个月至2年的随访,效果满意.结论 垂直于扩张范围小切口埋置扩张器,并早期开始快速扩张,可以最大限度地缩短扩张时间,减轻疼痛,是一种较好的皮肤软组织扩张方法.     

导管外置式皮肤扩张术752例应用研究

目的:研究导管外置式皮肤扩张方法的临床应用,为整形外科提供简单、安全的皮肤扩张新技术。方法:选择皮肤扩张术适应证患者752例,经皮肤小切口作扩张区皮下间隙剥离并埋入扩张器,术后4d开始间断注水扩张。观察扩张期并发症发生率和皮肤扩张失败率。结果:752例共1 883个扩张部位,扩张时间30~113d,平均82.7d。总并发症244个,总并发症发生率为12.96%。其中,感染并发症为8.66%,扩张器外露并发症为4.30%,两组比较差别显著(P<0.05)。感染性扩张失败率为0.64%,扩张器外露性扩张失败率为0.85%,两组比较差别显著(P<0.05)。结论:导管外置式皮肤扩张术总并发症发生率在正常范围。感染并发症发生率没有增加。对皮肤扩张术安全构成最大威协的并发症是扩张器外露。所以,导管外置式皮肤扩张术是安全、可行的,可进一步推广应用。     

短程持续组织扩张技术的临床应用

目的：研究住院周期最短的理想快速扩张法。方法：选择１１７例皮肤瘢痕患者,分成间断快速扩张组（ＩＦＴＥ）和短疗程持续扩张组（ＳＰＴＥ）。ＩＦＴＥ组采用平行切口埋植扩张器,术后１０天开始作间断快速扩张。ＳＰＴＥ组经垂直小切口埋植扩张器,术中大量注水扩张,术后持续扩张。结果：所有患者均顺利完成快速扩张并获得满意治疗效果。ＩＦＴＥ组平均扩张时间１６．８天,平均住院时间为４５．３天。ＳＰＴＥ组平均扩张时间为     

Advantages of minimally invasive, balloon-dissector-assisted tissue expander placement: a clinical and experimental study

BACKGROUND: Tissue expansion has been dependent upon healing the access incision after placement. Delay can be reduced with minimally placed expanders. Smaller, remote incisions allow for earlier expansion. METHODS: Balloon-assisted tissue expander placement was evaluated in a pig model and compared with open placement. Open placement with delayed expansion versus minimally invasive placement with immediate expansion, and open placement with immediate expansion versus balloon dissection with delayed expansion were compared. Our clinical series with balloon dissector tissue-expander placement was reviewed. Fifty-two tissue expanders were placed minimally invasively and successfully expanded. RESULTS: Use of balloon dissector in the pig model yielded a shorter reconstructive period, faster expansion, and greater flap advancement. Clinical results revealed no infections, dehiscence, extrusion, or hematomas. All cases had expansion begun intraoperatively and were successfully expanded. CONCLUSIONS: Minimally invasively placed expanders resulted in shorter expansion times, the ability to institute immediate expansion, and improved expansion compared with open placement.     

The role of tissue expansion in abdominal wall reconstruction

Abdominal wall reconstruction of ventral hernia defects with loss of visceral domain and inadequate soft-tissue coverage presents a surgical challenge. Four patients with large, skin grafted ventral hernia defects were treated by staged abdominal wall reconstruction. During the initial stage, tissue expanders were placed under the skin and subcutaneous tissue lateral to the defects. After adequate interval expansion, the second stage was performed. The expanders were removed, the visceral contents reduced easily, and the fascia reapproximated with polypropylene mesh. The expanded skin was closed easily over the fascial repair. All four patients were reconstructed successfully without complications. Tissue expansion can restore abdominal domain and allow soft-tissue closure in complicated ventral hernia defects.     

bFGF和硫糖铝在组织扩张术中的应用

目的：探索碱性居纤维细胞生长因子（bFGF）和硫糖铝在扩张术中的临床应用方法与效果。方法：皮肤瘢痕及鼻尖缺损患者共12例，经病变外边缘垂直切口埋置扩张器23个，持续恒免疫组化检测。结果：术后1－3d即可开始持续扩张，平均扩张时间为8．9d；第一、二期手术间隔平均13．5d，平均住院时间为28．4d。扩张后皮肤软组织即时回缩率平均25．7％，皮瓣全部皮活。组织学、PCNA检测显示表皮层明显增厚、细胞层数增加，胶原纤维排列较密，弹力纤维、成纤维细胞、毛细血管密度增高；增生期基底细胞增多，分布广泛。结论：采用此法扩张速度快，能明显缩知疗程，提高皮瓣质量，改善治疗效果。     

应用扩张后皮瓣修复乳房下部瘢痕

目的 探寻乳房下部瘢痕挛缩的较佳治疗方法. 方法 对2000年7月-2007年7月笔者单位收治的9例乳房下部瘢痕挛缩女性患者,行乳房周围皮肤扩张术.扩张器埋置切口多选择在乳房下部瘢痕处,置入部位以乳房周围侧胸部、胸部中央剑突附近为佳,且侧胸部置入时尽量使扩张器位置向上,与乳房上级水平齐平.扩张器埋置层次在深筋膜下及腺体表面.Ⅱ期充分松解挛缩的瘢痕,使腺体及乳房恢复正常解剖位置,将扩张后皮瓣设计成直接推进或易位皮瓣修复缺损,或直接拉拢缝合封闭创面. 结果 除1例患者皮瓣尖端4.0 cm×3.0 cm范围发生血运障碍,经植皮后创面愈合外,其余8例皮瓣均成活,创面愈合;所有患者乳晕、乳头均恢复正常解剖位置.其中3例6个月～2年后复诊,效果满意. 结论 应用扩张后皮瓣修复乳房下部瘢痕挛缩,效果良好.     

First experience of endoscopic implantation of tissue expanders in plastic and reconstructive surgery

Background: Over the last 15 years, tissue expansion has been used in the treatment of 324 patients at the A. V. Vishnevsky Institute of Surgery. The principal drawbacks of the traditional technique for tissue expansion are the prolonged time needed to complete the process and a high rate of complications. With the traditional technique, the wound created by the implantation of the expander inhibits the expansion of the tissue until healing takes place, which requires 10–14 days. However, attempts to reduce of the length of the incision have been limited by the necessity to ensure good hemostasis in the expander pocket. We describe our initial experience with the endoscopic insertion of tissue expanders. Methods: We performed the endoscopic implantation of 20 tissue expanders in nine patients. Six patients had postburn scar deformities, one had congenital microtia, one had a capillary malformation, and one had a capillary malformation combined with postburn scar deformity. Tissue expanders were inserted in the head, face, neck, chest wall, scapular, shoulder, forearm, and calf regions. The endoscopic technique was specially adapted according to the features of the different anatomic sites. Endoscopy enabled creation of the expander pocket, with good control of hemostasis, through incisions 1 cm. The orientation of these incisions was parallel to forces of tension. Therefore, full expansion began immediately after placement of the expander, without any risk of postoperative wound dehiscence. The expanders were fully inflated intraoperatively accordingly to the principals followed in the traditional technique of implantation for inflation over a 3-week period. Further inflations were carried out regularly either daily or once every other day. Results: The average time required for the tissue expansion was 34 days, which was less than half the time needed with the traditional technique. All flaps remained extant after reconstruction with the expanded tissues. There were no complications. Conclusion: The advantages of the endoscopic implantation of tissue expanders are a reduction in expansion time, a shorter hospital stay, less patient discomfort, and the prevention of complications (hematoma, seroma, infection, wound dehiscence). Presented at the 10th International Congress of the European Association for Endoscopic Surgery (EAES), Lisbon, Portugal, 2–5 June 2002     

Endoscopic tissue expansion placement in face and neck burn scar reconstruction

Introduction

Reconstruction of the face and neck after burn necessitates high-quality tissue for improving the appearance. Tissue expansion provides a greater opportunity, but, unfortunately, with relatively high complication rates. One potential alternative to reduce these complications is to place the expander with the assistance of the endoscope. In this study, we evaluated endoscopically assisted tissue-expander placement for the treatment of face and neck deformities after burn.

Materials and methods

Age, gender, site of burn to be reconstructed, shape and volume of expander inserted, expander volume reached after expansion, time reached to maximum volume expansion and complications for all patients having undergone endoscopically assisted tissue-expander placement were recorded during the period of the study. The details of the procedure used were described.

Results

A total of 14 expanders were placed assisted by an endoscope in 11 patients between April 2008 and October 2009. Anatomically, five expanders were placed in the neck, six expanders were placed in the cheek and three expanders were placed in the forehead. In all cases, tissue expansion was achieved without major complications; minor port complications occurred in two cases.

Conclusion

Endoscopically assisted tissue-expander placement allows for the use of smaller incisions, which can be placed in more cosmetically acceptable areas and away from the expansion site. This benefit would reduce the risk of wound dehiscence, and permits expansion to be initiated earlier. We believe that this technique is a safe and effective method that needs to be confirmed with a comparative study.     

A new multipurpose retractor and dissector

Summary Dissection of large subcutaneous pockets has been fabricated using a new retractor dissector. Pockets for tissue expanders and various prostheses can be created through small incisions. Retraction during insertion of silastic prostheses is simplified.