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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 4
Figure 1 A 34 year old patient with a large hairy nevus since birth measuring 2.8 by 3.7 cm in the upper aspect of the right forehead. A few days of pre operative tissue expansion simplifies a difficult procedure. It allows the physician to move the nevus into the hairline as much as possible, permits the nevus to be adequately excised and the wound to be closed primarily by suture at surgery without undermining and without a graft. There is minimal deformity and the excisional 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 three days prior to surgery. At surgery there was an abundant amount of extra skin and subcutaneous tissue and the nevus was excised. 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 3 There was a, two day Proxiderm application and followed by a single day of Proxiderm tissue expansion prior to excision of nevus. At surgery the tissue was extremely relaxed and the nevus was excised. The excisional wound was closed by suture near the hairline with no undermining or distortion of the eyelids or nearby facial features. There was a additional one day application of Proxiderms to reduce the tension on the suture line. Figure 4 Appearance at 9 months Case Report 5
Figure 1 A 26 year old patient born with bilateral cleft lip. At the time of repair, the patient had almost no lip. The cleft palate was repaired and the patient talks normally. At present there is a large defect in the mid-portion of the upper lip. There was just a nubbin for the upper lip in the central portion. Figure 2 A few days of pre operative tissue expansion simplifies a difficult procedure. An Abbe flap procedure is avoided by utilizing the Proxiderm to obtain additional tension free skin and subcutaneous tissue prior to the surgical procedure to correct the defect.
Figure 3 Four days prior to surgery the physician used Proxiderm model D 90 460. The patient was evaluated on the second day and it was decided that another two day application of Proxiderms were required to obtain more tissue. Figure 4 At the time of surgery there was enough extra tissue to avoid an Abbe flap and the defect
was repaired. Appearance at 6 months. Cleft lip repaired with no undermining or distortion of facial features. Case Report 6
Figure 1 A 7 year old patient with a nevus measuring 5.5 cm by 3.1 cm. 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 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 are inserted into the opposing edges of the nevus. Proxiderms were applied seven days prior to surgery. After two days of Proxiderm tissue expansion, the patient was evaluated, and it was decided that another two day application of Proxiderms were required to obtain more tissue, the nevus was sutured to hold the stretch. The patient was evaluated on the 4th day and when another application of Proxiderms was decided upon.
Figure 3 Combines are placed between, under the edges and on top of the Proxiderms and the patient is wrapped in Kling and an Unna backed Barton bandage. Figure 4 On the 7th day, at surgery the tissue was extremely relaxed and the nevus was excised.
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. There was an abundant amount of skin
and subcutaneous tissue and the excisional wound was closed by suture without undermining or distortion of nearby facial features. Appearance at one year. Case Report 7
Figure 1 A 32 year old patient with a chronic scleroderma on the forehead and eyebrow area. Pre operative tissue expansion simplifies a difficult procedure. It allows the defect 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 three days prior to surgery. Tissue hooks of the Proxiderm are inserted as deep as possible into the opposing edges of the defect. Combines are placed between, under the edges and on top of the Proxiderms and the patient is wrapped in an Unna backed Barton bandage. There were 2 daily applications of Proxiderms. At surgery the defect was excised and the wound closed primarily by suture without undermining or distortion of facial features Figure 3 Proxiderm models D 460 were applied to suture line for two more days to allow the suture line to heal in a tension free environment.
Figure 4 Appearance at 3 months. |
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