A way of “making” more skin…
Tissue expansion enables the body to “grow” extra skin for use in reconstructing almost any part of the body. The procedure is used widely in breast reconstruction and scalp reconstruction. A tissue expander is a silicone plastic balloon buy may not necessarily be round. It is placed under the skin and then increased in size with weakly injections of sterile salt water. In this manner, Dr. Bentkover can create more skin for reconstructing a defect of your face or scalp. Often, the expander is placed 3 or 4 months before a Mohs Excision for skin cancer. That way, when the tumor is excised, he will have enough skin in the area to reconstruct the defect with an appropriate skin flap.
Dr. Bentkover uses tissue expansion most commonly for repairing or replacing areas of the scalp, most commonly in conjunction with skin cancer removal. Tissue expansion is ideal for scalp repair, because the “expanded” skin on the scalp retains normal hair growth. Following tissue expansion, the repaired scalp looks very natural. Tissue expansion also generally produces excellent results when reconstructing other areas of the face and neck, the hands, arms, and legs.
Advantages and Disadvantages
Before tissue expansion, surgeons were often limited with regard to the types of skin flaps and skin grafts they could use to reconstruct damaged or missing tissue on the body. Tissue expansion provides an a technique with several advantages. First, tissue expansion offers an excellent match of color, texture, and hair-bearing qualities. Second, because the skin remains connected to the donor area’s blood and nerve supply, there is a smaller risk that it will die after being moved into the area to be reconstructed. And thirdly, the blood supply to the expanded skin is often better than the the original skin in the area.
The only significant drawbacks of tissue expansion are the length of time required to grow additional skin and the number of weekly office visits required to accomplish that. The process usually takes 3-4 months. Duringthat time there may be a visible bulge in the area of expansion as the expander is gradually enlarged with weekly injections. Despite these drawbacks, tissue expansion can produce very natural looking results.
The size and location of the defect to be reconstructed or the anticipated size of, for example, a Mohs surgery defect are important factors in considering whether or not tissue expansion may be required. Your age, skin condition, medical history and other medical factors will help him determine if you are a candidate for tissue expansion. Your time flexibility and tolerance for the inconvenience associated with this procedure will also help you decide whether it is right for you.
Our staff will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and medications. You must stop smoking at least two weeks before the placement of the expander. You must stop all anticoagulant medications and herbal preparations such as aspirin, ibuprofen, vitamin E, gingko, St. John’s Wart, garlic tablets or ginseng 10 days prior to surgery. You may be required to take antibiotics to prevent infection. You should shampoo your hair the night before surgery.
Surgery is usually done on an outpatient basis. You should arrange for someone to drive you home after your surgery and to help you out for a day or two if needed. Both the insertion of the expander and the secondary reconstructive procedure (once the area is expanded) will usually be done under general anesthesia. The initial operation will most likely take an hour or so, depending on the size and area of skin being expanded. A discreet incision is made next to the area of skin to be excised or repaired, and the silicone balloon expander is inserted in a pocket created beneath the skin. The expander includes a tiny tube and a self-sealing injection port that allows Dr. Bentkover to gradually fill the expander with saline solution. This injection port is usually left just beneath the surface of the skin. Once in place, the expander is gradually filled with salt water through the injection port.
Beginning about 10 days after the insertion of the expander, Dr. Bentkover will begin weekly injections of the expander in his office. As the expander enlarges, your skin will stretch. This may cause minor discomfort for a couple of hours after each injection. Any discomfort you experience may be controlled with mild pain medication.
When the skin has stretched enough to cover the area to be reconstructed, you will have a second operation to remove the expander and reposition the new tissue.
After the Surgery
The speed of your recovery depends on the extent of the surgery. Most patients can resume fairly normal activity within a week or two following the second surgery. As with any cosmetic or reconstructive surgery, realistic expectations are important. Patients in good physical and psychological health will benefit from this procedure the most.
Complications are very rare in this procedure. Although expanders are thoroughly tested and carefully inserted, leaks can occur. If the expander leaks, the saline solution will be harmlessly absorbed by your body; another procedure would be required to replace the expander. Rarely, an infection may develop around the expander. In some cases, the expander may need to be removed for several months until the infection clears. A new expander can then be inserted.
A procedure that actually increases the amount of skin in a specific area with the help of an expandable balloon-like device under the skin.
You will usually return to work in 7- 10 days or so. Expansion is done through a series of relatively painless injections in our office on a weekly basis for 12-16 weeks.