Reconstruction With Osmotic Tissue Expander – Analysis of 25 Consecutive Cases

Background:

Osmotic expander is a self-filling device which absorbs fluids in order to achieve tissue expansion. Its unique characteristics include expansion through osmotic action to a definite stable volume which renders external filling unnecessary. One of its main limitations is inability to control the filling rate and halt it or even reduce it in case of tissue intolerance (1-3).

Purpose:

We present our experience with 25 consecutive cases of tissue reconstruction using osmotic expanders. We wish to emphasize the main advantages and limitations of this device.

Methods and materials:

The present study was launched in May, 2008, since when twenty five patients (14 females), median age 28 years (range 3-55) were reconstructed using an osmotic expander. The reasons for using tissue expander included large congenital nevi (72%) and scars. Body areas treated included: scalp (32%), neck (16%), shoulder (8%), chest (4%), upper extremities (20%) and lower extremities (20%). In 80% of the patients one osmotic expander was used for each patient, in 16%, two osmotic expanders were used and in 4%, four expanders were used.

Results:

In all of the cases, the operative and post-operative management was uneventful. Patients were released one day after the operation. During the expansion period, there were 2 (range 1-3) outpatient clinical visits. The average expansion time was 10 weeks (range 5-20). In 12% (three patients) there was partial extrusion of the expander, with local damage to the surrounding tissue. This necessitated earlier removal of the expanders and reconstruction under sub-optimal conditions. In two of these cases final aesthetic results were inferior.

Conclusion:

Osmotic expander is a reliable tool for tissue expansion. The final shape and size are precisely predictable. The main advantages of this device include its initial small size which allows for a small surgical incision and a short overall operating time. The expansion period is shorter and more convenient for the patient. The need for external filling injections is eliminated and the risk of infection is low. The main disadvantages include the inability to control the filling rate and the need to remove the expander in case of damage to the overlying tissue. Although this is not common, it should be taken in consideration because when it does happen earlier reconstruction becomes necessary with inferior final results.