About Tissue Expansion
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“Tissue expansion is an important technique for reconstruction of soft tissue defects. It is commonly used in the care of burns, breast re¬construction and pediatric plastic surgery. The phenomenon of tissue expansion is well known and observed in pregnancy. Skin expands in response to tension generated by the increased abdominal volume during pregnancy. This response has been found to be a metabolically active process resulting in increased mitotic activity and vascularity of the expanded skin.
Tissue expansion for medical purposes was first reported in 1905 by Codvilla who attempted to lengthen tissue in the hip area. Neuman, in 1957, used controlled tissue expansion with a rubber balloon to aid in reconstruction of an ear defect. Interest in tissue expansion then waned until the late 1970’s. Techniques were developed for breast reconstruction over the course of the next decade. Pioneering this technique was Radovan in 1982. Since that time, tissue expansion has become an accepted standard technique in providing soft tissue coverage of increasingly complex wounds.
Tissue expansion in the field of lower extremity wound care has also undergone an evolution over the past several decades. Mechanical skin stretching was attempted with devices such as the Sure Clo¬sure Skin Stretching System®. However, the rigors of adjusting the device proved to be an obstacle to its continued use. Recently a device has been developed that provides continuous tissue expansion for enhancing lower extremity wound healing.”
(From Continuous Tissue Expansion An effective method for enhanced lower extremity wound healing by Andrew Rader DPM, American Society of Podiatric Medical Assistants Quarter Two – 2010)
The DermaClose® RC continuous external tissue expander is an innovative alternative to traditional, and often complex, procedures used for closing chronic and acute wounds.
Here is how the DermaClose® RC works:
Skin anchors, made of 316L surgical stainless steel are placed approximately 1.5 cm from the edge of the wound. These anchors penetrate the skin into the subcutaneous tissue. Each anchor is then stapled twice with a standard skin stapler.
Once the anchors are in place, the line from the DermaClose® tension controller is attached around each skin anchor and the knob of the tensioning device is rotated until a clutch mechanism provides an audible indication that full tension has been achieved. The DermaClose® now automatically maintains the proper amount of tension to gently expand the skin on the subcutaneous planes around the wound until the edges of the wound are brought close enough together for final suturing and closure.
The DermaClose® RC is a sterile, single patient use device. The stainless steel skin anchors penetrate the skin to 4.5 mm into the subcutaneous tissue, and are held in place with two standard skin staples. A stapler and staple remover are included with the kit. The tension controller is just 1.7 inches wide, 2.6 inches long, 0.8 inches high and is made of ABS plastic. The nylon suture loop is 26 cm long. Multiple devices can be used for large wounds.