A few days of preoperative external tissue expansion can simplify a difficult procedure.   It quickly creates additional tension free local site skin and sub cutaneous tissue that has a satisfactory match in color, thickness and texture to harmonize with the surrounding tissue.  It is less traumatic, results in a quicker recovery and reduces the need for serial excision of a nevus or a hypertrophic scar.

Case Report  1

Figure 1 Figure 2

Figure 1   An 85 year old patient required excision of a squamous cell carcinoma of the face.  Pre operative tissue expansion allows the tumor to be adequately excised and closed primarily by suture at surgery without undermining and without a graft.  There is minimal deformity and the wound is approximated with normal local tissue.

Figure 2   The physician used Proxiderm model TN 460 to obtain additional tension free skin and sub cutaneous tissue prior to surgery.  Tissue hooks of the Proxiderm are inserted into the opposing edges of the tumor.  Proxiderms were applied twice on intervals of two days.

Figure 3 Figure 4

Figure 3   At surgery there was an abundant amount of extra skin and subcutaneous tissue. The tumor was widely excised and the physician was able to bring skin and subcutaneous together with ease and close the wound primarily by suture at surgery without undermining or distortion of facial features.  Appearance at 3 days post closure.

Figure 4   Appearance at one year.

Case Report  2

Figure 1 Figure 2 Figure 3

Figure 1   A 22 year old patient with a large hairy nevus of the entire side of her face, nose and into the area of the lower eyelid.    Pre operative tissue expansion eliminates the need for serial excision of the nevus over a time period of many months.   It allows the nevus to be adequately excised and closed primarily by suture at surgery with no undermining and  without a graft.  There is minimal  deformity and the wound is approximated with normal local tissue

Figure 2   The physician used Proxiderm model TN 460 to obtain additional tension free skin and sub cutaneous tissue prior to surgery. Tissue hooks of the Proxiderm are inserted as deep as possible into the opposing edges of the nevus.   

Figure 3   Combines are placed between, under the edges and on top of the Proxiderms and the patient is wrapped in an Unna backed Barton bandage.

Figure 4 Figure 5

Figure 4     Appearance at 2 days post expansion.   As the Proxiderms expands nearby tissue the nevus invaginates into the cheek area and the nevus is sutured to hold the stretch.

Figure 5   Appearance at 6 days.  There were 4 days of Proxiderm tissue expansion.   The nevus is totally invaginated into the cheek area and held in place by suture.   There was one additional day of Proxiderm tissue expansion prior to excision of the nevus.

Figure 6 Figure 7

Figure 6       The excision of the nevus was carried down through the suprafascial fat and fascia onto the deep fascia.   The physician was able to remove the entire nevus.  The tissue was extremely relaxed and the excisional wound was closed by suture with no undermining or distortion of nearby facial features. Full thickness skin graft applied to left ala and nose.  Appearance at one year.

Figure 7   Appearance at two years.

Case Report  3

Figure 1 Figure 2

Figure 1   A 23 year old patient with a thick elevated hypertrophic scar on the forehead. Pre operative tissue expansion simplifies a difficult procedure. It allows the hypertrophic scar to be adequately excised and closed primarily by suture at surgery with no undermining and without a graft.   There is minimal deformity and the wound is approximated with normal local tissue

Figure 2   The physician used Proxiderm model TN 460 to obtain additional tension free skin and sub cutaneous tissue prior to surgery. Tissue hooks of the Proxiderm are inserted as deep as possible into the opposing edges of the hypertrophic scar. There were two, two day applications of Proxiderms.  At surgery there was an abundant amount of extra skin and subcutaneous tissue and the hypertrophic scar was excised. The excisional wound was closed by suture with no undermining or distortion of nearby facial features.

Figure 3 Figure 4 Figure 5

Figure 3   There was a additional one day application of Proxiderms reduce tension on the suture line.

Figure 4     Appearance of  dressing.   Combines are placed between, under the edges and on top of the Proxiderms and the patient is wrapped in an Unna backed Barton bandage.

Figure 5 Appearance at 3 months

Additional Cases

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