Wieslander J B
Department of Plastic and Reconstructive Surgery, Malmö General Hospital, Sweden.
Scand J Plast Reconstr Surg Hand Surg. 1991;25(1):47-56. doi: 10.3109/02844319109034923.
More than 100 patients (38 in the head and neck) have been treated by the insertion of tissue expanders since the technique was introduced six years ago. Our methods have been refined as we have learned more, and these improvements are described. Morbidity is high when untrained surgeons start to use the technique. The most important decision is the planning of the expander and filling port pockets, but above all the location of the incision(s): Incisions must be kept small and away from the defect, the pocket, and the future flap. Intraoperative filling of the expander reduces the need for drains by preventing haematoma and seroma formation, and reduces the formation of expander envelope folds. The optimal location of the valve is a "quiet" area above or lateral to (or both) the expander, and at least 7 cm away. Mathematical formulas are useless in predicting available flap length, as elasticity and contractility depend on individual factors. A good estimation of flap length is twice the height of the expander above the skin surface or the distance over the dome of the expander minus the corresponding measurement of its base. Overexpansion by 30-50% makes the procedure more predictable.
自六年前引入组织扩张器植入技术以来，已有100多名患者（38例头颈部患者）接受了该治疗。随着我们了解得越来越多，我们的方法也得到了改进，并对这些改进进行了描述。未经培训的外科医生开始使用该技术时，并发症发生率很高。最重要的决策是扩张器和填充端口腔隙的规划，但最重要的是切口的位置：切口必须小且远离缺损、腔隙和未来的皮瓣。术中向扩张器内注水可预防血肿和血清肿形成，从而减少引流需求，并减少扩张器包膜褶皱的形成。阀门的最佳位置是在扩张器上方或侧面（或两者皆有）的“安静”区域，且距离至少7厘米。数学公式在预测可用皮瓣长度方面毫无用处，因为弹性和收缩性取决于个体因素。皮瓣长度的良好估计是扩张器在皮肤表面上方高度的两倍，或扩张器顶部的距离减去其底部的相应测量值。过度扩张30%-50%可使手术更具可预测性。
