Tissue expansion is a technique for obtaining skin tissue that closely matches the contour and color of defect areas through skin expansion, enhancing surface area and vascularization. Key benefits include similarity in color and texture, hair growth on expanded skin, minimal scarring, preserved skin sensitivity, and reduced morbidity in donor areas. The document discusses indications, contraindications, surgical principles, potential complications, and relevant literature on tissue expansion.

1. Tissue
Expansion
Robertus Arian Datusanantyo
Prof. M. Sjaifuddin Noer, dr., SpB, SpBP-RE (K)

2. 2 J. / L/ 7 th/ 12-05-17 – Photograph by EAN

3. ---Tissue Expansion ---
Salah satu metode mendapatkan jaringan kulit
dengan kontur dan warna yang mirip dengan
daerah defek dengan memanfaatkan ekspansi
kulit yang menyebabkan peningkatan luas
permukaan dan vaskularisasi.
3 Bauer (2007)

4. 4 Sumber: http://veiledlife.blogspot.co.id

5. 5 Foto oleh Abraham Joffe untuk http://dailymail.co.uk

6. 6 Source: http://www.huffingtonpost.com

7. Keuntungan
1. Warna + tekstur sama,
2. Penumbuhan rambut pada kulit
terekspansi,
3. Minimalnya parut,
4. Dipertahankannya sensibilitas kulit,
5. Berkurangnya morbiditas daerah donor,
6. Hematom/infeksi è mudah diulang.
7 Sharpe & Burd (1989); McCauley (2005); Khalatbari & Bakhshaeekia (2013)

8. 8 Takei et al. (1998)
Patofisiologi

9. Perubahan pada Jaringan
9 Agrawal & Agrawal (2012); Hoffmann (2005); John et al. (2015); McCauley (2005)
Epidermis Dermis Otot Tulang
Jaringan
Lemak
Pembuluh
Darah
Jaringan
Saraf

10. Kulit
1. Penebalan epidermis di stratum spongiosum
2. Mitosis meningkat tiga kali lipat selama
ekspansi lalu kembali normal setelah 2-5 hari
3. Penipisan dermis terutama dermis retikularis
4. Peningkatan jumlah fibroblas aktif
10 Agrawal & Agrawal 2012

11. Pembuluh Darah
1. Proliferasi pembuluh darah yang
signifikan
2. Pembuluh kapiler distensi dan jumlah
arteriola dan venula meningkat
3. Peningkatan aliran darah
11 Argenta & Marks 2006

12. Saraf
1. Memanjang seiring ekspansi bertahap
2. Fungsi mungkin menurun
12 Argenta & Marks 2006

13. Indikasi
1. Pasien stabil secara emosional
2. Memerlukan penutupan defek
3. Memungkinkan perencanaan dengan
waktu panjang
13 Argenta & Marks (2006)

14. Kontra Indikasi
1. Menolak multi-operasi / non komplians
2. Disabilitas mental
3. Vaskularisasi buruk (sedang/pasca
radioterapi)
4. Infeksi aktif
5. Luka terbuka
14 John et. al. (2006)

15. 15 Agrawal & Agrawal (2012)
Spherical Rectangular
Cylindrical Crescent

16. Prinsip Dasar
1. Perencanaan detil
2. Hilangkan dead space (antara jaringan dan
ekspander)
3. Mulai ekspansi 1-2 minggu
4. Volume sedikit demi sedikit, lebih sering
5. Periksa kulit post ekspansi
16 (Bauer 2007; Argenta & Marks 2006).

17. Perencanaan Detil
1. Sayatan awal è flap
2. Merekonstruksi dari unit estetik
3. Bekas luka tidak mencolok
4. Ketegangan pada jahitan minimal
17 ( Argenta & Marks 2006).

18. 18 Zaal & van der Horst (2009)

19. 19 Lentz & Bauer (2014)

20. 20 Khalatbari & Bakhshaeekia (2013)

21. 21 Filho et al. (2007)

22. 22 Marks & Argenta (2013)

23. 23 Filho et al. (2007)

24. 24 Runz et al. (2016)

25. 25 Sohet & Heymans (2007)

26. 26 Sohet & Heymans (2007)

27. Komplikasi
1. Infeksi
2. Kegagalan implan
3. Ekspander terekspos
4. Kegagalan saat penjahitan flap
27 Argenta & Marks 2006

28. Catatan Khusus
1. Ekspansi pada ekstremitas
2. Ekspansi pada pasien anak / muda
3. Radioterapi
28
Chen et al. (2016); Fochtmann et al. (2013); Argenta & Marks (2006); Bozkurt
et al. (2008); Pandya et al. (2002); Donelan (2007)

29. Kepustakaan
Agrawal, K. & Agrawal, S., 2012. Tissue regeneration during tissue expansion and choosing an
expander. Indian Journal of Plastic Surgery, 45(1), pp.7–15.
Argenta, L.C. & Marks, M.W., 2006. Principles of Tissue Expansion. In S. J. Mathes, ed. Plastic
Surgery, Vol. 1: General Principles. Saunders, pp. 539–567.
Bauer, B.S., 2007. Tissue Expansion. In C. H. Thorne et al., eds. Grabb and Smith’s Plastic Surgery.
Philadelphia: Lippincott Williams & Wilkins, pp. 84–90.
Bozkurt, A. et al., 2008. Retrospective analysis of tissue expansion in reconstructive burn surgery:
Evaluation of complication rates. Burns, 34(8), pp.1113–1118.
Donelan, M.B., 2007. Principles of Burn Reconstruction. In C. H. Thorne et al., eds. Grabb and
Smith’s Plastic Surgery. Philadelphia: Lippincott Williams & Wilkins, pp. 150–161.
Fochtmann, A. et al., 2013. Tissue expansion for correction of scars due to burn and other causes:
A retrospective comparative study of various complications. Burns, 39(5), pp.984–989.
Hoffmann, J.F., 2005. Tissue expansion in the head and neck. Facial Plastic Surgery Clinics of
North America, 13(2), pp.315–324.
Khalatbari, B. & Bakhshaeekia, A., 2013. Ten-year experience in face and neck unit reconstruction
using tissue expanders. Burns, 39(3), pp.522–527. Available at: http://dx.doi.org/10.1016/
j.burns.2012.07.020.
Marks, M.W. & Argenta, L.C., 2013. Principles and applications of tissue expansion. In P. C.
Neligan & J. Chang, eds. Plastic Surgery. Elsevier Inc., pp. 621–653.e3.
Pandya, A., Vadodaria, S. & Coleman, D., 2002. Tissue expansion in the limbs: a comparative
analysis of limb and non-limb sites. British Journal of Plastic Surgery, 55(4), pp.302–306.
Takei, T. et al., 1998. Molecular Basis for Tissue Expansion: Clinical Implications for the Surgeon.
Plastic and Reconstructive Surgery, 101(1), pp.247–258.
Wagh, M.S. & Dixit, V., 2013. Tissue expansion: Concepts, techniques and unfavourable results.
Indian Journal of Plastic Surgery, 46(2), pp.333–348.
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30. Terima Kasih