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Pregnancy as a tissue expander in the correction of a scar deformity
American Journal of Obstetrics and Gynecology (2004) 190, 579e80
www.elsevier.com/locate/ajog
Pregnancy as a tissue expander in the correction of a scar deformity Barbara Del Frari, MD,a,* Petra Pu¨lzl, MD,a Thomas Schoeller, MD,a Martin Widschwendter, MD,b Gottfried Wechselberger, MDa Department of Plastic and Reconstructive Surgery, Leopold-Franzens University, and Ludwig Boltzmann Institute for Quality Control in Plastic and Reconstructive Surgery,a Department of Obstetrics and Gynecology of University Hospital Innsbruck,b Innsbruck, Austria
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– KEY WORDS Pregnancy Tissue expander Scar deformity
Tissue expansion is an established method for the correction of scars and tissue defects. During pregnancy the abdominal skin becomes gradually stretched over the growing uterus, providing a ‘‘natural’’ tissue expander. We present a case of a woman with posttraumatic scarring of the lower abdomen and thigh where tissue expansion during pregnancy was successfully used for scar correction. Ó 2004 Elsevier Inc. All rights reserved.
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– The concept of tissue expansion is well described in the medical literature. Expanders can be placed subcutaneously, subfascially, or intra-abdominally to facilitate soft tissue coverage. Similarly, abdominal skin becomes gradually stretched over the expanding uterus during pregnancy. Previously, tissue expansion caused by pregnancy has been described for ventral hernia repair and a case of postburn reconstruction of the abdomen.1,2 We present a case in which this method was used to correct a severe posttraumatic scar deformity and soft tissue defect of the lower abdomen.
Case report A 14-year-old girl injured in a traffic accident had severe vascular and soft tissue trauma of the right lower abdo-
* Reprint requests: Barbara Del Frari, MD, Department of Plastic and Reconstructive Surgery, Leopold-Franzens University of Innsbruck, Anichstr 35, 6020 Innsbruck, Austria. E-mail: [email protected] 0002-9378/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.ajog.2003.09.018
men, groin area, and thigh. Initial treatment consisted of vascular reconstruction of the femoral artery, debridement, and split-thickness skin grafts. For soft tissue reconstruction and esthetic improvement of the grafted area, we recommended 1 year postoperatively treatment with skin expanders, which the patient declined. She was subsequently lost to follow-up. At the age of 24 years the patient was seen again; she was 8 months pregnant. Her reason for consultation at this time was to ask for the possibility of using the expanded abdominal skin for scar correction. Clinical examination showed a scar deformity at the right lower abdomen, groin, and ventral thigh. Surgery was performed 1 week after an uncomplicated vaginal delivery. The native soft tissue was abundant; the expanded full-thickness lower abdominal skin was elevated along the abdominal fascia up to the navel. The previously placed split-thickness skin grafts in the region of the lower abdomen and groin were excised, and the defect was covered with the expanded skin. The postoperative and postpartum course was uneventful, and mother and baby were discharged on the third postoperative
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Del Frari et al
Figure Left, Pregnancy as natural tissue expander, 10 years after the accident. Top right, Posttraumatic scarring, 1 year after the accident. Bottom right, Six months after scar correction.
day. Follow-up after 6 months revealed a markedly improved esthetic appearance (Figure).
Comment Tissue expanders have been used successfully to provide adequate soft tissue coverage after traumatic loss and after temporary closure has been achieved with splitthickness skin grafts. Although tissue expansion is a staged procedure that requires a lengthy time period before definitive coverage is achieved, it has the advantage that reconstruction can then be performed with well-vascularized, innervated, autologous tissue. In our patient, the correction of scar contracture after posttraumatic soft tissue defect was obtained with an
autologous tissue expander. During pregnancy the abdominal skin becomes gradually stretched over the growing uterus, providing an ideal intra-abdominal tissue expander. In case of scar deformities or soft tissue defects at the abdominal region, this type of endogenous tissue expansion is a useful tool for reconstruction and is worth consideration.
References 1. Eric T, Walter L, Grant W. Pregnancy as a tissue expander in the repair of massive ventral hernia. Ann Plast Surg 2000;45:431-3. 2. DiGregorio VR. Two unusual post-burn reconstructions using tissue expansion one exogenous and one endogenous. Ann Plast Surg 1993;30:549-51.
www.elsevier.com/locate/ajog
Pregnancy as a tissue expander in the correction of a scar deformity Barbara Del Frari, MD,a,* Petra Pu¨lzl, MD,a Thomas Schoeller, MD,a Martin Widschwendter, MD,b Gottfried Wechselberger, MDa Department of Plastic and Reconstructive Surgery, Leopold-Franzens University, and Ludwig Boltzmann Institute for Quality Control in Plastic and Reconstructive Surgery,a Department of Obstetrics and Gynecology of University Hospital Innsbruck,b Innsbruck, Austria
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– KEY WORDS Pregnancy Tissue expander Scar deformity
Tissue expansion is an established method for the correction of scars and tissue defects. During pregnancy the abdominal skin becomes gradually stretched over the growing uterus, providing a ‘‘natural’’ tissue expander. We present a case of a woman with posttraumatic scarring of the lower abdomen and thigh where tissue expansion during pregnancy was successfully used for scar correction. Ó 2004 Elsevier Inc. All rights reserved.
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– The concept of tissue expansion is well described in the medical literature. Expanders can be placed subcutaneously, subfascially, or intra-abdominally to facilitate soft tissue coverage. Similarly, abdominal skin becomes gradually stretched over the expanding uterus during pregnancy. Previously, tissue expansion caused by pregnancy has been described for ventral hernia repair and a case of postburn reconstruction of the abdomen.1,2 We present a case in which this method was used to correct a severe posttraumatic scar deformity and soft tissue defect of the lower abdomen.
Case report A 14-year-old girl injured in a traffic accident had severe vascular and soft tissue trauma of the right lower abdo-
* Reprint requests: Barbara Del Frari, MD, Department of Plastic and Reconstructive Surgery, Leopold-Franzens University of Innsbruck, Anichstr 35, 6020 Innsbruck, Austria. E-mail: [email protected] 0002-9378/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.ajog.2003.09.018
men, groin area, and thigh. Initial treatment consisted of vascular reconstruction of the femoral artery, debridement, and split-thickness skin grafts. For soft tissue reconstruction and esthetic improvement of the grafted area, we recommended 1 year postoperatively treatment with skin expanders, which the patient declined. She was subsequently lost to follow-up. At the age of 24 years the patient was seen again; she was 8 months pregnant. Her reason for consultation at this time was to ask for the possibility of using the expanded abdominal skin for scar correction. Clinical examination showed a scar deformity at the right lower abdomen, groin, and ventral thigh. Surgery was performed 1 week after an uncomplicated vaginal delivery. The native soft tissue was abundant; the expanded full-thickness lower abdominal skin was elevated along the abdominal fascia up to the navel. The previously placed split-thickness skin grafts in the region of the lower abdomen and groin were excised, and the defect was covered with the expanded skin. The postoperative and postpartum course was uneventful, and mother and baby were discharged on the third postoperative
580
Del Frari et al
Figure Left, Pregnancy as natural tissue expander, 10 years after the accident. Top right, Posttraumatic scarring, 1 year after the accident. Bottom right, Six months after scar correction.
day. Follow-up after 6 months revealed a markedly improved esthetic appearance (Figure).
Comment Tissue expanders have been used successfully to provide adequate soft tissue coverage after traumatic loss and after temporary closure has been achieved with splitthickness skin grafts. Although tissue expansion is a staged procedure that requires a lengthy time period before definitive coverage is achieved, it has the advantage that reconstruction can then be performed with well-vascularized, innervated, autologous tissue. In our patient, the correction of scar contracture after posttraumatic soft tissue defect was obtained with an
autologous tissue expander. During pregnancy the abdominal skin becomes gradually stretched over the growing uterus, providing an ideal intra-abdominal tissue expander. In case of scar deformities or soft tissue defects at the abdominal region, this type of endogenous tissue expansion is a useful tool for reconstruction and is worth consideration.
References 1. Eric T, Walter L, Grant W. Pregnancy as a tissue expander in the repair of massive ventral hernia. Ann Plast Surg 2000;45:431-3. 2. DiGregorio VR. Two unusual post-burn reconstructions using tissue expansion one exogenous and one endogenous. Ann Plast Surg 1993;30:549-51.