Tissue Expansion and Serial Excision in Scar Revision

ABSTRACT

Scars in the head and neck caused by trauma or extirpative surgery can present a significant problem to the patient and may require revision. A variety of techniques, both surgical and nonsurgical, exists for treatment of unsightly scars. Surgical excision of scars relies upon recruitment of local tissue for closure of the ensuing defect. Tissue expansion and serial scar excision may be used to provide more tissue for advancement or local flap coverage of revised scars. Herein we review the history, technique, and complications of tissue expansion and serial excision as well as the basic scientific principles underlying these techniques.

KEYWORD

Tissue expansion - review - serial excision - scar revision

REFERENCES

• 1 Murakami C S, Nishioka G J. Essential concepts in the design of local skin flaps.  Fac Plast Surg Clin North Am . 1996;  4 455-468
• 2 Gibson T, Kenedi R M. Biomechanical properties of skin.  Surg Clin North Am . 1967;  47 279-294
• 3 Holt G R. Tissue Expansion in Reconstruction. In: Bailey BJ, ed. Head and Neck Surgery-Otolaryngology, 2nd ed Philadelphia: Lippincott-Raven 1998: 2453-2463
• 4 Gibson T. The physical properties of skin. In: Converse JM, ed. Reconstructive Plastic Surgery Philadelphia: WB Saunders 1977: 70-77
• 5 Marks R. Mechanical properties of the skin. In: Goldsmith LA, ed. Biochemistry and Physiology of the Skin New York: Oxford University Press 1983: 1237-1254
• 6 Marcus J, Horan D B, Robinson J K. Tissue expansion: past, present, and future.  J Am Acad Dermatol . 1990;  23 813-825
• 7 Fung Y C. Bioviscoelastic Solids: Biomechanics-Mechanical Properties of Living Tissues.  New York: Springer-Verlag 1981: 196
• 8 Burnett W. Yank meets native.  Natl Geogr . 1945;  88 105-128
• 9 Weeks G S. Into the heart of Africa.  Natl Geogr . 1956;  110 257-263
• 10 Patterson T JS. The Zeiss Index and History of Plastic Surgery.  Baltimore: Williams & Wilkins 1977: 1-3
• 11 Bennett R G, Hirt M. A history of tissue expansion. Concepts, controversies, and complications.  J Dermatol Surg Oncol . 1993;  19 1066-1073
• 12 Neumann C G. The expansion of an area of skin by progressive distention of the subcutaneous balloon.  Plast Reconstr Surg . 1957;  19 124-130
• 13 Radovan C. Breast reconstruction after mastectomy using the temporary expander.  Plast Reconstr Surg . 1982;  69 195-208
• 14 Radovan C. Tissue expansion in soft-tissue reconstruction.  Plast Reconstr Surg . 1984;  74 482-492
• 15 Austad E D. Evolution of the concept of tissue expansion.  Fac Plast Surg . 1988;  5 277-279
• 16 Squier C A. The stretching of mouse skin in vivo: effect on epidermal proliferation and thickness.  J Invest Dermatol . 1980;  74 68-71
• 17 Lew D, Fuseler J W. The effect of stepwise expansion on the mitotic activity and vascularity of subdermal tissue and induced capsule in the rat.  J Oral Maxillofac Surg . 1991;  49 848-853
• 18 Pasyk K A, Argenta L C, Hassett C. Quantitative analysis of the thickness of human skin and subcutaneous tissue following controlled expansion with a silicone implant [see comments].  Plast Reconstr Surg . 1988;  81 516-523
• 19 Lew D, Fuseler J W. The effect of pulsed expansion of subfascially placed expanders on the extent and duration of mitosis in the capsule and rat integument.  J Oral Maxillofac Surg . 1993;  51 154-158
• 20 Mandy S H. Intraoperative expander-assisted scalp reduction.  J Dermatol Surg Oncol . 1993;  19 1117-1119
• 21 Frodel Jr L J, Whitaker D C. Primary reconstruction of congenital facial lesion defects with tissue expansion.  J Dermatol Surg Oncol . 1993;  19 1110-1116
• 22 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
• 23 Johnson T M, Lowe L, Brown M D, Sullivan M J, Nelson B R. Histology and physiology of tissue expansion.  J Dermatol Surg Oncol . 1993;  19 1074-1078
• 24 Chun J T, Rohrich R J. Versatility of tissue expansion in head and neck burn reconstruction.  Ann Plast Surg . 1998;  41 11-16
• 25 Stark R B. Resurfacing the face.  Clin Plast Surg . 1975;  2 577-583
• 26 Buhrer D P, Huang T T, Yee H W, Blackwell S J. Treatment of burn alopecia with tissue expanders in children.  Plast Reconstr Surg . 1988;  81 512-515
• 27 Baker S R, Swanson N A. Tissue expansion of the head and neck. Indications, technique, and complications [see comments].  Arch Otolaryngol Head Neck Surg . 1990;  116 1147-1153
• 28 Antonyshyn O, Gruss J S, Mackinnon S E, Zuker R. Complications of soft tissue expansion.  Br J Plast Surg . 1988;  41 239-250
• 29 Matton G E, Tonnard P L, Monstrey S J, Van Landuyt H K. A universal incision for tissue expander insertion.  Br J Plast Surg . 1995;  48 172-176
• 30 Schmelzeisen R, Schimming R, Schwipper V, Heydecke G. Influence of tissue expanders on the growing craniofacial skeleton.  J Craniomaxillofac Surg . 1999;  27 153-159
• 31 Brown M D, Johnson T M. Complications of tissue expansion.  J Dermatol Surg Oncol . 1993;  19 1120-1122
• 32 van Rappard H J, Molenaar J, van Doorn K, Sonneveld G J, Borghouts J M. Surface-area increase in tissue expansion.  Plast Reconstr Surg . 1988;  82 833-839
• 33 Roenigk R K, Wheeland R G. Tissue expansion in cicatricial alopecia.  Arch Dermatol . 1987;  123 641-646
• 34 Sasaki G H. Intraoperative sustained limited expansion (ISLE) as an immediate reconstructive technique.  Clin Plast Surg . 1987;  14 563-573
• 35 Masser M R. Tissue expansion: a reconstructive revolution or a cornucopia of complications?.  Br J Plast Surg . 1990;  43 344-348
• 36 Argenta L C, Marks M W, Pasyk K A. Advances in tissue expansion.  Clin Plast Surg . 1985;  12 159-171