Tissue expanders in surgery.

The technique of tissue expansion using inflatable expanders has gained widespread attention in the surgical literature. We give two examples of its use and emphasise possible complications which may arise. The search for methods to close complex wounds, often associated with radiation-damaged tissue or exposed bone, has resulted in a progression from random skin flaps to axial pattern flaps with a longer length to breadth ratio guaranteed by anatomically constant vessels. Musculocutaneous, fasciocutaneous and free flaps have been described over the body surface allowing complex reconstruction at local and distant sites. The use of expansion is of particular value in allowing local tissue to fill defects with minimal functional and aesthetic disturbance. In the face and scalp, in particular, tissue expansion appears to be a promising method of at least partially removing disfiguring lesions and is useful in reconstruction following traumatic loss. The concept of tissue expansion in medicine is not new. During pregnancy the abdominal skin becomes gradually stretched over the expanding uterus. Large skin excisions can be carried out in abdominoplasty following weight loss. Skin and mucosa can be seen to expand rapidly over benign enlarging neoplasms. The serial excision of large naevi has been practised for many years by plastic surgeons. Skin grafts placed over fasciotomy wounds to obtain tension-free closure can be subsequently excised in stages to obtain a minimally stretched linear scar.