A Minimally Invasive Approach to the Placement of Tissue Expanders

ABSTRACT

Plastic surgeons are frequently faced with difficult and challenging soft tissue defects in all areas of the body. To reconstruct these defects, there are many operative approaches available to the reconstructive surgeon including skin grafts, local flaps, regional flaps, and free-tissue transfer. Despite these many options, occasionally the best alternative for reconstruction of a wound is tissue expansion, where skin of similar quality, texture, and color can be used to close a soft tissue defect. Unfortunately, there are significant problems related to tissue expander reconstruction including a complication rate as high as 50%. As a result, tissue expander reconstruction has not achieved the widespread popularity commensurate with its potential clinical utility. To reduce the complication rate related to open tissue expander placement, and consequently to improve its clinical utility, we have employed endoscopic techniques for the placement of tissue expanders. Endoscopic approaches are currently being used in many areas of surgery and have resulted in substantial benefits. Endoscopic placement of tissue expanders has the benefit of reducing operative time, major complication rate, time to full expansion, and length of hospital stay. The purpose of this article is to critically examine the current open technique for tissue expander placement and to compare this technique with minimally invasive endoscopic tissue expander placement. We will discuss in detail the current problems associated with open tissue expander placement, the benefits of endoscopic tissue expansion, the technique of endoscopic tissue expander placement, and the outcomes for these techniques.

Endoscopy - endoscopic plastic surgery - tissue expansion

REFERENCES

• 1 Neumann C G. The expansion of an area of skin by progressive distention of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear.  Plast Reconstr Surg. 1957;  19 124-130
• 2 Cunha M S, Nakamoto H A, Herson M R, Faes J C, Gemperli R, Ferreira M C. Tissue expander complications in plastic surgery: a 10-year experience.  Rev Hosp Clin Fac Med Sao Paulo. 2002;  57 93-97
• 3 Chun J T, Rohrich R J. Versatility of tissue expansion in head and neck burn reconstruction.  Ann Plast Surg. 1998;  41 11-16
• 4 Radovan C. Tissue expansion in soft-tissue reconstruction.  Plast Reconstr Surg. 1984;  74 482-492
• 5 van Rappard J H, Molenaar J, van Doorn K, Sonneveld G J, Borghouts J M. Surface-area increase in tissue expansion.  Plast Reconstr Surg. 1988;  82 833-839
• 6 Manders E K, Schenden M J, Furrey J A, Hetzler P T, Davis T S, Graham III W P. Soft-tissue expansion: concepts and complications.  Plast Reconstr Surg. 1984;  74 493-507
• 7 Austad E D, Thomas S B, Pasyk K. Tissue expansion: dividend or loan?.  Plast Reconstr Surg. 1986;  78 63-67
• 8 Cherry G W, Austad E, Pasyk K, McClatchey K, Rohrich R J. Increased survival and vascularity of random-pattern skin flaps elevated in controlled, expanded skin.  Plast Reconstr Surg. 1983;  72 680-687
• 9 Argenta L C, Marks M W, Pasyk K A. Advances in tissue expansion.  Clin Plast Surg. 1985;  12 159-171
• 10 Iconomou T G, Michelow B J, Zuker R M. Tissue expansion in the pediatric patient.  Ann Plast Surg. 1993;  31 134-140
• 11 Mackinnon S E, Gruss J S. Soft tissue expanders in upper limb surgery.  J Hand Surg [Am]. 1985;  10 749-754
• 12 Marks M W, Argenta L C, Thornton J W. Burn management: the role of tissue expansion.  Clin Plast Surg. 1987;  14 543-548
• 13 Pisarski G P, Mertens D, Warden G D, Neale H W. Tissue expander complications in the pediatric burn patient.  Plast Reconstr Surg. 1998;  102 1008-1012
• 14 Bauer B S, Vicari F A, Richard M E. The role of tissue expansion in pediatric plastic surgery.  Clin Plast Surg. 1990;  17 101-112
• 15 Van Beek A L, Adson M H. Tissue expansion in the upper extremity.  Clin Plast Surg. 1987;  14 535-542
• 16 Austad E D, Rose G L. A self-inflating tissue expander.  Plast Reconstr Surg. 1982;  70 588-594
• 17 Antonyshyn O, Gruss J S, Mackinnon S E, Zuker R. Complications of soft tissue expansion.  Br J Plast Surg. 1988;  41 239-250
• 18 Librero J, Marin M, Peiro S, Munujos A V. Exploring the impact of complications on length of stay in major surgery diagnosis-related groups.  Int J Qual Health Care. 2004;  16 51-57
• 19 Masser M R. Tissue expansion: a reconstructive revolution or a cornucopia of complications?.  Br J Plast Surg. 1990;  43 344-348
• 20 Fong P H, Yeap C L, Lee S T. Tissue expanders in reconstructive surgery.  Ann Acad Med Singapore. 1987;  16 349-352
• 21 Lau W Y, Leow C K, Li A K. History of endoscopic and laparoscopic surgery.  World J Surg. 1997;  21 444-453
• 22 Gordon A G, Magos A L. The development of laparoscopic surgery.  Baillieres Clin Obstet Gynaecol. 1989;  3 429-449
• 23 McGee M F, Rosen M J, Marks J et al.. A primer on natural orifice transluminal endoscopic surgery: building a new paradigm.  Surg Innov. 2006;  13 86-93
• 24 Teimourian B, Kroll S S. Subcutaneous endoscopy in suction lipectomy.  Plast Reconstr Surg. 1984;  74 708-711
• 25 Poindexter B D, Vasconez L O. The present status of endoscopy.  Ann Plast Surg. 1998;  41 679-683
• 26 Isse N G. Endoscopic facial rejuvenation: endoforehead, the functional lift. Case reports.  Aesthetic Plast Surg. 1994;  18 21-29
• 27 Ramirez O M. Endoscopic full facelift.  Aesthetic Plast Surg. 1994;  18 363-371
• 28 Vasconez L O, Core G B, Gamboa-Bobadilla M, Guzman G, Askren C, Yamamoto Y. Endoscopic techniques in coronal brow lifting.  Plast Reconstr Surg. 1994;  94 788-793
• 29 Aly A, Avila E, Cram A E. Endoscopic plastic surgery.  Surg Clin North Am. 2000;  80 1373-1382
• 30 Guller U, Hervey S, Purves H et al.. Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database.  Ann Surg. 2004;  239 43-52
• 31 Erbella J, Behmand R, Cederna P S. A minimally invasive approach to the correction of pectus excavatum.  Surg Laparosc Endosc Percutan Tech. 2001;  11 213-217
• 32 Braga M, Vignali A, Gianotti L et al.. Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome.  Ann Surg. 2002;  236 759-766 disscussion 767
• 33 Makhoul B, De La Taille A, Vordos D et al.. Laparoscopic radical nephrectomy for T1 renal cancer: the gold standard? A comparison of laparoscopic vs open nephrectomy.  BJU Int. 2004;  93 67-70
• 34 Serra J M, Benito J R, Monner J, Zayuelas J, Parraga A. Tissue expansion with endoscopy.  Ann Plast Surg. 1997;  38 101-108
• 35 Sharobaro V I, Moroz V Y, Starkov Y G, Strekalovsky V P. First experience of endoscopic implantation of tissue expanders in plastic and reconstructive surgery.  Surg Endosc. 2004;  18 513-517
• 36 Bass E B, Pitt H A, Lillemoe K D. Cost-effectiveness of laparoscopic cholecystectomy versus open cholecystectomy.  Am J Surg. 1993;  165 466-471
• 37 Borschel G H, Izenberg P H, Cederna P S. Endoscopically assisted reconstruction of male and female poland syndrome.  Plast Reconstr Surg. 2002;  109 1536-1543
• 38 Toranto J D, Yu D, Cederna P S. Endoscopic versus open tissue expander placement: is less invasive better?.  Plast Reconstr Surg. 2007;  119 894-906