Cairo Plastic Clinic 

Scars can occur after burns, accidents, or skin lesions. Replacing defective skin can be a challenging problem, and skin grafts (once very popular) usually end up with a worse cosmetic appearance than the scarred skin.

In the latter quarter of the last century, tissue expansion was introduced and has since enjoyed a wide range of applications since it allows resurfacing of wide defects with neighboring skin similar in color, texture, sensation, and retained hairs and sweat glands.

It is based on the principle of increasing the area of adjacent normal skin, and then using it to replace the area of defective skin.

 What are Tissue Expanders?

Tissue expanders are silicone bags that come in different sizes and shapes. The most commonly used are the rectangular, rounded or crescentic expanders, but other shapes are available for more specific locations. Sizes of the expanders vary from 50 ml to 800 ml, and sometimes even more, depending on the area of skin available for expansion.

Am I a good candidate for Tissue Expansion?

The best candidates for tissue expansion are those who have an ugly scarred area of skin next to a healthy area. Tissue expansion can be used anywhere in the body, but best results are achieved when the expander is placed against a hard surface (e.g against the skull bones during scalp expansion), this enables maximal expansion of tissues.  Expansion in areas such as the limbs and neck demand more care and extra precautions.

Tissue Expansion Consultation

During your consultation, Dr. Wilson will measure the area of deformed scarred skin, and plan the area to be expanded in adjacent normal skin. He will decide the number of tissue expanders needed to be placed, their shape, volume and base size. He will consider the design and location of each expander, and give you a rough estimate of the duration of time needed to achieve full expansion.

In advanced complicated cases, more than one session of tissue expansion will be planned, and Dr. Wilson will lay out a plan of the timetable required achieve the ultimate desired result.

How is Tissue Expansion Surgery Performed?

The surgery is carried out in two stages:

1- One or more deflated expander are inserted under the  healthy skin adjacent to the scarred ugly area.  This surgery can be done under local or general anesthesia, although the latter is preferable when multiple expanders are inserted. 

After a delay of 7-10 days, the expander is inflated in the office of Dr. Wilson, usually twice weekly. The amount of fluid injected in the expander per session depends on its initial size, and the quality of overlying skin. The duration of expansion can last 3-10 weeks depending on the size of the expander.

2- The second surgery is performed when the expander is fully inflated. Under general anesthesia, the expander s removed and ugly scar is also excised. Then the healthy expanded skin is rotated to cover the defect after removing the ugly scar.

A thin line is all that results after suturing the new skin in place. 

 What are the Risks?

A major issues to avoid during tissue expansion is infection since this may lead to extrusion of the expander. Another major issue to be aware of is  to avoid being pricked by any sharp needle in the area of the expander since this may lead to its rupture. Other minor risks  include seroma formation and expander migration.

Tissue Expansion in a 6 year old girl to treat a burn scar in the face and cheek: A 350 ml tissue expander was inserted under the healthy neck skin, and inflated over 8 weeks to increase the area of healthy skin. Then scar in face and cheek was removed, and healthy expanded skin from the neck used to replace it.  

Tissue Expansion in MOHAMED SABRY , a 23 year old boy  to treat a  scar in the forearm from drug addiction injections: A 100 ml tissue expander was inserted under the healthy forearm skin, and inflated over 3 weeks to increase the area of healthy skin. Then scar was removed, and healthy expanded skin used to replace it. 

And excised scar

 And Early Final Result

 And Late Final result , picture provided by the patient

 Tissue Expansion in a 16 year old girl to treat a burn scar in the right breast and abdomen: Four 550 ml tissue expanders were inserted under the healthy abdominal and flank skin, and inflated over 12 weeks to increase the area of healthy skin. Then scar in breast and abdomen  was removed, and healthy expanded skin  used to replace it. 

 Tissue Expansion in a 16 year old girl to treat a burn scar in the right trunk and abdomen: Five 300-550 ml tissue expanders were inserted under the healthy abdominal and flank skin, and inflated over 4 weeks to increase the area of healthy skin. Then scar in flank and abdomen  was removed, and healthy expanded skin  used to replace it. 

With the expanders inserted and fully inflated.

After removal of expanders and burn scars, leading to final appearance.

 Tissue Expansion in a 29 year old man to treat a burn scar in the back: Four 300-550 ml tissue expanders were inserted under the healthy back skin and inflated over 3 weeks to increase the area of healthy skin. Then scar in back  was removed, and healthy expanded skin  used to replace it. 

 

And Fully Expanded Skin:

And Removed Scarred skin:

And Final Outcome 3 days after surgery: