Objective To improve the efficiency of skin soft tissueexpansion with the overlapping tissue expansion techniques. Methods From June 2003 to March 2005, 5 cases of skin soft tissue defects were treated with the overlapping tissue expansion techniquetwo overlapped expanders in one soft tissue pocket, which was different from the traditional technique——one expander in one soft tissue pocket. Five patients included 3 males and 2 females, aging from 11 to 28 years. The defect was caused by scar of forearm in 2 cases, by melanotic nevus in 1 caseand by cicatricial baldness in 2 cases. The disease course was 1.5 to 24 years. Thedefect size ranged from 12 cm×5 cm to 13 cm×12 cm. Results Skin expansion process was satisfactory and skin defect was completely repaired with the expanded skin tissue in one operation in 5 cases. After operation, the wound of donor-recipient site healed by first intention. All patients were followed up from 3 to 15months, no contracture, pigmentation and scar occurred at the expanded skin area. The long-term appearances were satisfactory. Conclusion Compare with the traditional tissue expansion techniques, the new overlapping tissue expansion techniques can apparently improve the efficiency of skin soft tissue expansion. Itis suitable for the patients whose expandable skin is limited or no more skin tissue can be dissected near the skin defect and who need more expandable skin torepair skin defect.
Abstract In order to have more selective sources of skin flaps to repair soft tissue defects, the prefabricated flap combining with skin expander was tried. Implanted the dorsal thoracic artery and vein with a muscle bundle of latissimus dorsi into the lateral thoracic wall subdermally andset a skin expander subcutaneously. Injected saline into the expander to inflate the flap gradually. In a month, an axial flap with the dorsal thoracic vesselswas prepared. the flap was transferred to the defect by vascular anastomosis technique. This method was applied in two cases, one to the left ankle, another to the left side of the neck. The sizes of the two flaps were 20cm×14cmand 22cm×15cm respectively. After operation, the flaps were alive completely. The advantages included selective source of vascular pedicle, thinpliable flap with enough blood supply, and direct closure of the donor site without skin graft.
This study was performed on adult canines. After expansion of 1—3 days the skin was analysised with image-analysis-system, and its ultrastructures were observed with electronic microscopy.Results were: (1)There was no obvious changes of the thickness of the skin during the three days after expansion; (2)At the summit and middle of the skin from expansion of 1—2 days, the fibroblasts were enlarged increased in number, and more mitochondria and rough endoplasmic reticulums were found in the cytoplasm; (3) Succinate dehydrogenase(SDH)and the coiiagenous fibers were obviously increased at the summit and middle of the skin after expansion of 1-2 days (Plt;0.05), but SDH became weak and the coiiagenous fibers were decreased on the third day ,and (4) It was also found that the elastic fibers were decreased at the summit and middle the skin after expansion on 1-2 days,and at the middle and the periphery of the skin on the thirt day.