- Tissue expansion
Keeping living tissues under tension causes new cells to form and the amount of tissue to increase. In some cases, this may be accomplished by the implantation of inflatable balloons under the skin (see figure). By far the most common method, the surgeon inserts the inflatable expander beneath the skin and periodically, over weeks or months, injects a saline solution to slowly stretch the overlaying skin. The growth of tissue is permanent, but will retact to some degree when the expander is removed. [Neumann CG. The expansion of an area of skin by the progressive distension of a subcutaneous balloon. "Plastic Reconstructive Surgery" 1957;19:124-30.] .
Breast reconstructionsurgery, for example, can use this technique when the mammary glandwas removed by surgery ( mastectomy). Later, a more permanent breast implant filled with saline or silicone gel is inserted under the expanded skin pocket.
In other applications, excess skin is grown purposely by expansion on the back or the buttocks, so that it can be harvested later for transplantation to another site where skin was lost due to trauma, extensive
wounds, surgery, burns, etc.
Tissue expansion has also been used for the technique of
foreskin restoration, which is usually non-surgical and applies tension externally using specialized devices to replace circumcised tissues with new cells. [Radovan C. [http://www.cirp.org/library/restoration/radovan1/ "Tissue expansion in soft-tissue reconstruction] ". "Plast Reconstr Surg" 1984;74(4):482-92.]
Boneis another tissue that can be expanded relatively easily, by using external devices which are slowly separated using mechanical contraptions, so that bone grows in response to elongation ( bone distractor). Other techniques and external devices have been studied and have shown some success, such as in the fitbone surgery. [ [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14745629&dopt=Abstract External tissue expansion successfully achieved using negative pressure] Zagazig University, Zagazig City, Sharkia, Egypt 2004] This technique was pioneered in 1951 by the Russian physicianIlizarov, and is called the Ilizarov apparatus. It is capable of lengthening limbs in cases of pathological loss of bone, asymmetry of limbs, dwarfism, short stature, etc. In reconstructive and cosmetic surgery, bone expanders have been used to elongate the mandibulain cases of congenital disorders, trauma, tumors, etc. Other newer devices such as the orthofixand intramedullary skeletal kinetic distractor(ISKD) are also used for limb lengthening. It can add over 6 inches per bone, but is expensive, painful, and time-consuming (each procedure lasts around 8-12 months).
* [http://www.vardaan.net/ilizarov.htm Ilizarov apparatus] .
* [http://www2.nidcr.nih.gov/iyf/skin.html About Faces: Skin] . NICDR National Institutes of Health on-line exhibit. Source of the images used.
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