11960 Insertion of tissue expander(s) for other than breast, including subsequent expansion

Name of the Procedure:

Insertion of Tissue Expander(s) for Other than Breast

• Common names: Tissue Expansion Surgery
• Medical term: Non-Mammary Tissue Expansion

Summary

Tissue expansion is a surgical procedure used to grow extra skin for reconstructive purposes. This involves placing a balloon-like device called a tissue expander under the skin and gradually filling it with saline solution over time to stretch the skin.

Purpose

The procedure addresses the need for additional skin in reconstructive surgeries. It is typically used to repair skin defects, scars, or areas damaged due to trauma, surgery, or other conditions. The goal is to create extra skin that matches in color and texture with the surrounding area, providing better aesthetic and functional results.

Indications

• Large or complex scars needing revision
• Skin loss due to trauma or surgery
• Congenital skin defects
• Reconstructive needs for areas like the scalp, neck, and limbs
• Adequately healthy skin around the affected area to allow expansion

Preparation

• Patients may be instructed to fast for 6-8 hours prior to the procedure.
• Medication adjustments might be required, particularly blood thinners.
• Preoperative assessments such as blood tests and imaging studies may be necessary to evaluate overall health and the specific area for expansion.

Procedure Description

1. The surgeon makes a small incision near the target area.
2. A silicone balloon (tissue expander) is inserted under the skin.
3. The incision is closed, and a small valve connected to the expander remains accessible under the skin.
4. Over the following weeks to months, saline is gradually injected into the expander through the valve, slowly stretching the skin.
5. Once adequate skin has been grown, a secondary surgery is performed to remove the expander and use the newly grown skin for the required reconstructive purpose.
   • Tools and equipment: Tissue expander, saline solution, syringe with a valve access port.
   • Anesthesia: General or local anesthesia with sedation, depending on the case.

Duration

• Initial insertion: 1-2 hours
• Expansion process: Several weeks to months
• Final reconstructive surgery: Varies, typically 2-4 hours

Setting

The procedure is typically performed in a hospital or surgical center.

Personnel

• Surgeons specialized in reconstructive or plastic surgery.
• Nurses and surgical technicians.
• Anesthesiologists for managing anesthesia.

Risks and Complications

• Common: Pain, swelling, bruising, infection at the insertion site.
• Rare: Expander rupture, unfavorable scarring, skin necrosis, allergic reaction to anesthesia.
• Management: Antibiotics for infection, pain medication, possible removal or replacement of expander if complications arise.

Benefits

• Creation of new skin that closely matches the size, texture, and color of the surrounding skin.
• Improved aesthetic and functional outcomes in the reconstructed area.
• The benefits are typically realized a few weeks after the final reconstructive surgery.

Recovery

• Post-procedure care: Wound care at the insertion site, pain management, avoiding strenuous activities.
• Expected recovery time: Varies, initial healing from the insertion takes about 1-2 weeks; full recovery following final reconstructive surgery may take several weeks.
• Follow-up appointments: Regular visits for saline injections, monitoring of the expansion, and post-operative checks.

Alternatives

• Skin grafting: Using skin from another part of the body.
  • Pros: Immediate availability of skin.
  • Cons: Risk of donor site complications, potential rejection, and color/texture mismatch.
• Flap surgery: Moving tissue from a neighboring area.
  • Pros: Better blood supply, good matching
  • Cons: More complex surgery, potential donor site issues.

Patient Experience

• During the initial procedure, patients are under anesthesia and should not feel pain.
• Some discomfort or pain in the days following insertion, managed with prescribed pain relief.
• Sensation of tightness and mild discomfort during the expansion phases, typically well-tolerated.
• Post-final surgery, patients should follow recovery instructions closely to ensure optimal healing and outcomes. Pain management and adequate rest play a key role in recovery.