Al Madani Jamal Omran
Plastic Surgery Unit, Plastic Surgery Resident, Security Forces Hospital, Riyadh, Saudi Arabia.
Plast Surg Int. 2014;2014:457205. doi: 10.1155/2014/457205. Epub 2014 Jan 23.
Background. Tissue expansion is a well-established surgical technique that produces an additional amount of normal skin to cover a defect. This technique is appealing because the skin quality and color are from the patient's own. The widely used injectable expanders are of great reliability but carry the disadvantage of being painful during injection and most of the time require multiple clinic visits. So the idea of self-inflation became attractive and hydrogel expanders were developed and became widely known for being painless during clinic visit and decrease number of visits. The first generation expanders were modified by adding an enclosing plastic shell to decrease the unopposed expansion that occurred in the first generation expanders, which lead to pressure necrosis of the skin flaps. This made it an attractive option for tissue expansion in children and some adult patients. Patients, Materials, and Methods. Charts of 17 patients were retrospectively reviewed, all of them had second generation self-inflating expanders implanted over a 2-year period for one of two purposes, the treatment of giant nevi or burn scars. Results. Fifteen patients were females and 2 were males. The indication was large burn scar in 14 cases (14/17), in which 47/55 expanders were implanted, and giant nevus in 3/17 cases in which 8/55 expanders were implanted. Extrusion of the expander occurred in 8/55 expanders (14.5%), which occurred in 6/14 patients. The highest percentage of extrusion occurred in the neck in which two out of three expanders extruded; otherwise this complication does not seem to be related to the indication, gender, nor age of the patients. It seems to be that it is technical in nature. The patients did not have to get any injections to fill the tissue expanders, which made the expansion process less painful and more convenient. Conclusion. This seems to be currently the largest published review in which second generation expanders were used. Those expanders seem to offer a desirable advantage of being painless for children, also they do not require repeated visits to the surgeon's clinic, which is of great value for patients living in the periphery.
背景。组织扩张术是一种成熟的外科技术，可产生额外的正常皮肤以覆盖缺损。该技术颇具吸引力，因为皮肤质量和颜色均来自患者自身。广泛使用的可注射扩张器具有很高的可靠性，但存在注射时疼痛的缺点，并且大多数情况下需要多次门诊就诊。因此，自我膨胀的想法变得具有吸引力，水凝胶扩张器应运而生，并因在门诊就诊时无痛且减少就诊次数而广为人知。第一代扩张器通过添加一个封闭的塑料外壳进行了改进，以减少第一代扩张器中出现的无对抗扩张，这种无对抗扩张会导致皮瓣压力性坏死。这使其成为儿童和一些成年患者组织扩张的有吸引力的选择。患者、材料与方法。对17例患者的病历进行了回顾性分析，所有患者在两年内植入了第二代自膨胀扩张器，目的有两个，即治疗巨大痣或烧伤瘢痕。结果。15例患者为女性，2例为男性。适应证为大面积烧伤瘢痕14例（14/17），其中植入扩张器47/55个；巨大痣3/17例，其中植入扩张器8/55个。8/55个扩张器（14.5%）发生了扩张器挤出，其中6/14例患者出现这种情况。挤出发生率最高的部位是颈部，三分之二的扩张器在此部位挤出；否则，这种并发症似乎与患者的适应证、性别和年龄无关。似乎本质上是技术性问题。患者无需注射来填充组织扩张器，这使得扩张过程疼痛减轻且更加方便。结论。这似乎是目前已发表的关于使用第二代扩张器的最大规模综述。这些扩张器似乎为儿童提供了无痛的理想优势，而且它们不需要反复前往外科医生诊所，这对生活在周边地区的患者具有重要价值。
