Tissue Expansion

Tissue expansion is a reconstructive technique used to repair certain types of wounds. 

What Is Tissue Expansion?

Tissue expansion involves the surgical placement of devices, called tissue expanders, at the edges of a wound or area of future excision (for example a large birthmark called a congenital nevus).  Tissue expanders are hollow, balloon-like devices that are attached to ports, through which sterile saline or water is injected over time.  7-10 days after placement of the tissue expanders, saline is injected into the expander in an office setting. This occurs on a weekly or bi-weekly basis until the expanders are filled, or enough skin has been expanded to close the wound or skin defect. The patient is then returned to the operating room, where the expanders are removed and the wound is closed with the expanded skin.

How does tissue expansion work?

When the skin is expanded with a tissue expander, two processes occur, called mechanical creep and biological creep.  With mechanical creep, the cells and tissue actually stretch, allowing the skin to expand.  This is followed by biological creep, in which cells actually proliferate, or divide and increase in number. This decreases the tension of the expanded skin.

When is tissue expansion an appropriate option?

There are many techniques plastic surgeons use for closure of wounds.  Smaller wounds can be allowed to heal on their own, a process called healing by secondary intention.  Alternatively, they may be able to be closed by undermining or releasing the surrounding skin and suturing.  Larger wounds may be treated by skin grafts or local flaps, in which nearby tissue is rearranged and advanced to close the wound.  For larger wounds, options include free flaps, is which tissue is taken from another part of the body and connected under a microscope to blood vessels near the wound (see microsurgery) or tissue expansion.  In certain areas of the body, the skin quality, thickness, and appearance differs from elsewhere, and tissue expansion offers the best technique for replacing lost tissue with very similar tissue.  Tissue expansion is also frequently used in breast reconstruction after mastectomy for breast cancer.

The following are examples in which tissue expansion is frequently used in reconstruction:

Scalp

Following breast reconstruction, the scalp is the second most common area of the body in which tissue expanders are used.  The scalp is a unique body area.  Because of its hair growth, there is simply no other area of the body that can replace scalp tissue without being very noticeable.  The scalp is also very amenable for reconstruction using tissue expansion; large areas of scalp can be reconstructed using tissue expansion.  Tissue expansion is used for scalp reconstruction when removing large congenital nevi, after trauma in which large areas of the scalp have been injured, and to replace areas of alopecia (hair loss) with hair-bearing scalp.

Congenital breast anomalies

As mentioned, tissue expansion is frequently used for breast reconstruction in patients with breast cancer.  Correction of congenital breast conditions such as Poland syndrome may involve several techniques, such as transfer of local or distant tissue flaps, tissue expansion, and the placement of breast implants.

Abdomen

Tissue expansion may be used in the abdomen for reconstruction of large abdominal defects caused by trauma, hernias, or omphalocele.  In addition, tissue expansion may be used to increase the amount of abdominal tissue used to reconstruct other areas of the body.

Back

Tissue expansion is frequently used in the pediatric population for reconstruction of large birthmarks called giant congenital nevi.  This technique can be successfully performed in young patients, and may require more than one treatment to completely remove very large lesions.

If you would like more information about this craniofacial anomaly, please contact the Craniofacial Team of Texas by calling 512-377-1142 or toll free 877-612-7069 to schedule an appointment or complete an online appointment request.