Tissue expansion
Encyclopedia
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
and restorative surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
s to cause the body to grow additional skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
, bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
or other tissues.
Skin expansion
When skin is stretched beyond its physiological limit mechanotransduction pathways are activated. This leads to cell
Cell (biology)
The cell is the basic structural and functional unit of all known living organisms. It is the smallest unit of life that is classified as a living thing, and is often called the building block of life. The Alberts text discusses how the "cellular building blocks" move to shape developing embryos....
growth as well as to the formation of new cells. In some cases, this may be accomplished by the implantation of inflatable balloons under the skin (see figure). By far the most common method, the surgeon inserts the inflatable expander beneath the skin and periodically, over weeks or months, injects a saline
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...
solution to slowly stretch the overlaying skin. The growth of tissue is permanent, but will retract to some degree when the expander is removed. Breast reconstruction
Breast reconstruction
Breast reconstruction is the rebuilding of a breast, usually in women. It involves using autologous tissue or prosthetic material to construct a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple...
surgery, for example, can use this technique when the mammary gland
Mammary gland
A mammary gland is an organ in mammals that produces milk to feed young offspring. Mammals get their name from the word "mammary". In ruminants such as cows, goats, and deer, the mammary glands are contained in their udders...
was removed by surgery (mastectomy
Mastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
). Later, a more permanent breast implant filled with saline or silicone gel is inserted under the expanded skin pocket.
In other applications, excess skin is grown purposely by expansion on the back or the buttocks, so that it can be harvested later for transplantation
Organ transplant
Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be...
to another site where skin was lost due to trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
, extensive wound
Wound
A wound is a type of injury in which skin is torn, cut or punctured , or where blunt force trauma causes a contusion . In pathology, it specifically refers to a sharp injury which damages the dermis of the skin.-Open:...
s, surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, burns
Burn (injury)
A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction. Most burns affect only the skin . Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured...
, etc. which is usually non-surgical and applies tension externally using specialized devices to replace circumcised tissues with new cells.
For Foreskin Restoration
Circumcised men can use non-surgical tissue expansion techniques to expand their surviving penile skin, making it a longer tube so it can function like a foreskinForeskin
In male human anatomy, the foreskin is a generally retractable double-layered fold of skin and mucous membrane that covers the glans penis and protects the urinary meatus when the penis is not erect...
. Methods may involve securing a tension strap or weight to the skin with tape, or gripping the skin with a tapeless foreskin restoration device
Restoration device
A restoration device is a device used for applying tension to skin during the process of non-surgical foreskin restoration. Those who use such a device employ the technique of tissue expansion, which causes new skin to grow.-History:...
that uses straps, or weights, or tension derived from internal expansion of the device. Some men succeed by tugging on the penile skin regularly with their fingers. The total time commitment to go from circumcised to an uncircumcised man's appearance and function might be 2 to 4 years (or more, depending on the severity of the circumcision
Circumcision
Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
) while tugging up to 12 hours per day. A foreskin restorer does not usually involve his doctor in the process.
In scalp reconstruction
Tissue expansion has been used on the scalp for treating scalp scarring, in lieu of hair transplation when there is insufficient donor hair to transplant on the scar or the scar tissue is not vascularized to support hair growth. For instance, in a patient who had melanomas removed from the scalp resulting in alopeciaAlopecia
Alopecia means loss of hair from the head or body. Alopecia can mean baldness, a term generally reserved for pattern alopecia or androgenic alopecia. Compulsive pulling of hair can also produce hair loss. Hairstyling routines such as tight ponytails or braids may induce Traction alopecia. Both...
defects (hair loss), even one of the most ancient stories of hair loss alopecia
Alopecia
Alopecia means loss of hair from the head or body. Alopecia can mean baldness, a term generally reserved for pattern alopecia or androgenic alopecia. Compulsive pulling of hair can also produce hair loss. Hairstyling routines such as tight ponytails or braids may induce Traction alopecia. Both...
is told in the Bible. tissue expansion can be used to allow for the removal of scars and complete hair coverage. The two main indications for choosing tissue expansion over hair grafting are the size and shape of the defect relative to potential supply of donor hair, and the quality and thickness of the scar tissue. Areas of significant scarring and/or tissue atrophy, which is likely to make hair grafting unsuccessful, are best excised and replaced by normal expanded scalp skin. Theoretically, there is no limit to the amount of tissue that can be created with tissue expansion, provided the process is conducted gradually.
Bone expansion
BoneBone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
is another tissue that can be expanded relatively easily, by using external devices which are slowly separated using mechanical contraptions, so that bone grows in response to elongation (bone distractor). Other techniques and external devices have been studied and have shown some success, such as in the fitbone surgery. This technique was pioneered in 1951 by the Russia
Russia
Russia or , officially known as both Russia and the Russian Federation , is a country in northern Eurasia. It is a federal semi-presidential republic, comprising 83 federal subjects...
n physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
Ilizarov, and is called the Ilizarov apparatus
Ilizarov apparatus
The Ilizarov apparatus is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique. It is used in surgical procedures to lengthen or reshape limb bones; to treat complex and/or open bone fractures; and in cases of infected non-unions of bones...
. It is capable of lengthening limbs in cases of pathological loss of bone, asymmetry of limbs, dwarfism
Dwarfism
Dwarfism is short stature resulting from a medical condition. It is sometimes defined as an adult height of less than 4 feet 10 inches , although this definition is problematic because short stature in itself is not a disorder....
, short stature, etc. In reconstructive and cosmetic surgery, bone expanders have been used to elongate the mandibula in cases of congenital disorder
Congenital disorder
A congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life , regardless of causation...
s, trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
, tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
s, etc. Other newer devices such as the orthofix and intramedullary skeletal kinetic distractor (ISKD) are also used for limb lengthening. It can add over 6 inches per bone, but is expensive, painful, and time-consuming (each procedure lasts around 8–12 months).
External links
- Ilizarov apparatus.
- About Faces: Skin. NICDR National Institutes of Health on-line exhibit. Source of the images used.
- Foundation for Hair Restoration