Nowadays, Tissue Expander became the one of the most popular techniques in the field of plastic surgery since it was introduced in 1976 by Radovan.1)
Although numerous reports on both clinical ana experimental experiences have been advocated, still there remains certain problems on its accurate indications and standard techniques for promising good results.
In this paper, we would like to discuss the concepts of favorable indications and technical pitfalls in the operative techniques through the clinical experiences of 117 cases from December, 1985 to May, 1988.
Among 117 cases, bum scar was the most common indication and rest of them are congenital anomalies, skin tumors, and other non-bum scar conditions. Furthermore the locations of lesions and ages of patients were evenly distributed, although slight female predominance was noted. Following are the conclusions that we have learned from the 117 cases dealt with.
1. The site of expander insertion need not be confined to the area just adjacent to the lesion. It can be located far from the lesion depend upon the final operative technique. More than one expander could be inserted for the correction of single lesion.
2. To expand the skin more effectively, tissue expander could be placed either above the fascia or under the fascia and the flap should be thin as possible.
3. The thickness of flap for expander should be even. The weak skin portion gives the chance of erosion of skin and resulted in the extrusion of expander subsequently.
4. Suture fixation between the incision line and expander is necessary to prevent the sliding movement of the expander to the incisional wound that contributes to the unwanted widening of incisional scar. 5. Connecting tube itself also needs the suture fixation to get rid of the unfavorable conditions such as torsion.
6. Once expanded skin flap could be re-expanded and staged expansion also guarantees better result.
7. Intervals between the insertion of expander and final operation do not necessarily correleate the outcome and maximum expansion is the gateway to the excellent results.
8. Capsulotomy must be limited to the distal portion of expanded skin not to jeopardize it
s vascular supply.
9. Shrinkage of expanded skin flap is not the major cause of postoperative widening of suture line, rather original tension of the flap itself is the main factor.
10. Inevitable depression or erosion of bone seems to be reversible, though not clarifed yet. So far as our cases concerned, it did minimum adverse effects to the final results.
Our experience dared us to state that the indication of the tissue expansion depends on the versatility of the expander, and well projected pre-operative planning is the upmost importance on its final results.
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