Over the last 25 years, tissue expansion has become one of the most important reconstructive techniques in plastic surgery. The technique has received a widespread use in reconstruction of both congenital and acquired defects, and in both aesthetic and functional reconstruction. The principle is a gradual enlargement of an elastic “balloon” placed under the skin next to the defect, thereby creating new skin.
An expanded local skin flap can be created with the same texture, colour and hair-growth as normal skin would have had in that location. The technique preserves skin sensitivity, even if this can be affected temporarily. Tissue expansion stretches the overlying skin and the subcutaneous tissues, recruits tissue from the surroundings and stimulates rapid growth. The same tissue (skin) can be expanded several times and thus large pre-fabricated flaps can be created. Tissue expansion is tissue engineering in vivo. The flap can even be created with a certain appearance (shape) and the location of the final scar can be chosen when the expansion is performed on both sides of the defect. Fabricated expanded tissue, such as skin, grows with the child. Tissue expansion can today be performed on three time-scales: intra-operatively (minutes), rapidly (weeks) and finally traditionally (months).
Giant Naevi – Birthmarks
Huge areas of defect skin can be removed, both on the trunk and on other parts of the body. This is done in several sessions. Large and multiple expanders can be used at the same time or in subsequent sessions. The boy below has a giant naevus on the front of the trunk. After tissue expansion and use of the newly created skin during several sessions, we see the results two years after the final reconstruction. The result is excellent and the skin quality is quite similar to that in the vicinity.
After special request, we perform tissue expansion at the Institute of Plastic Surgery, Western Harbour, Malmö, Sweden. Intra-operative rapid tissue expansion to remove smaller defects, such as skin grafts of the wrong colour, is also performed at the Institute of Plastic Surgery.