What is Soft Tissue Expansion and why is it so cool?
Soft Tissue expansion is where a device is used to stretch or “expand” tissue over large open defects caused by surgery or trauma. In the past, soft tissue expansion was used often in cancer surgery, where a large tumor or cancer was removed and there was a subsequent large defect that would take months to heal. Or in trauma cases such as a motor vehicle accidents where the patient suffers from injuries that cause large amount of tissue loss that could months to heal.
Soft tissue expansion is now being used in Limb Salvage and reconstruction. Dr. McLeod uses soft tissue expansion as a way to facilitate closure of large open wounds that not only would take months to heal, but due to their open nature, may introduce infection and and result in limb loss.
Once an infection has been cleared either via amputation or surgery, a soft tissue expander is placed to quickly stretch the tissues and close the large open wound. Soft Tissue expansion is especially useful in Diabetic Limb Salvage cases as the patient often can’t feel pain during the expansion or gradual stretching of the tissues due to peripheral neuropathy.
After 5-7 days of tissue expansion, the soft tissue expander is often removed and the wound is sutured closed. Sometimes, antibiotic beads may be placed in the wound before closure to ensure all bacteria are killed and to prevent an abscess (or pus pocket) from forming in the future. The sutures are usually left in about 3 weeks until the skin is fully mature.
When a transmetatarsal amputation is performed – that is the removal of all the toes and part of the metatarsal bones – an achilles tendon lengthening is needed. The achilles tendon is a large tendon on the back of the leg and this often needs to be lengthened in order to prevent a contracture. It is a simple procedure that involves 3 little small incisions on the back of the leg at the level of the achilles tendon. This is a very important step and is often neglected. The achilles tendon lengthening prevent the development of future contracture and ulceration, or break downs in the skin due to pressure.
Once all wounds are healed, the patient is then started in physical therapy and casted for diabetic shoes. This is another important step in the process of Limb Salvage and future Amputation Prevention.
The patient must then educated on how to prevent future ulcerations, infections, and amputations, and proper diabetic shoe wear. This is a crucial step that is often neglected.
Dr. Misako McLeod is a passionate Limb Salvage and Preservation expert in the Hawaii region. She utilizes every technique available from soft tissue expansion, skin grafting, hyperbaric oxygen therapy, and surgery to save a patient’s limb and prolong life.