FREE-FLAP EXPANSION USING BALLOON-ASSISTED ENDOSCOPIC TECHNIQUE

Pre-expansion of free flaps augments flap size dimensions and provides delay of tissue by opening ''choke'' vessels, thus augmenting the ter ritories of adjacent angiosomes. Pre-expansion of free tissue transfer s has been used for reconstruction of large soft tissue defects. A sec ondary benefit is that the donor site, traditionally treated by skin g raft, can be closed primarily. Using conventional techniques for free frap pre-expansion, blunt dissection may risk injury to the pedicle. U sing balloon dissectors a large optical cavity can be created quickly through an avascular fascial cleft. This allows endoscopic exploration of the optical cavity and confirmation of placement of the tissue exp ander. In addition, balloon-assisted endoscopic tissue expander placem ent optimizes the hysteresis effect of skin stretching and offers the possibility of immediate fluid inflation, which ultimately shortens th e time for free flap expansion prior to microsurgical transfer. (C) 19 97 Wiley-Liss, Inc.