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This case report illustrates the use of a Radovan tissue expander in a patient undergoing reconstruction of the upper two-thirds of the external ear. The expansion facilitated draping of the superior retro-auricular skin over the autogenous costal cartilage framework that was used for the skeletal reconstruction of the ear.

An aesthetically short nose is defined as a developmental deformity in which the nose appears foreshortened. It is characterized by a decreased distance from the nasofrontal angle (NFA) to the tip-defining points (TDP) and an increased nasolabial angle with increased nostril show. A method is described and illustrated for lengthening the aesthetically short nose by rotating the nasal tip in an inferior direction. This rotation results in an actual lengthening, as well as an illusion of lengthening of the nose.

Controlled clinical tissue expansion, a new technique of providing donor tissue, results in an increase in surface area of expanded skin. The aim of the present study was to determine the effect of controlled tissue expansion on the surviving lengths of random-pattern skin flaps elevated in expanded tissue. In five pigs the surviving lengths of flaps raised in skin expanded for 5 weeks using a 250-cc rectangular Radovan-type tissue expander were compared with the survival lengths of flaps elevated in tissue in which a similar prosthesis was not expanded, bipedicle flaps delayed for 5 weeks, and control acutely raised random-pattern flaps. The expanded flaps had a mean increase in surviving length of 117 percent over control flaps, which was statistically significant. The delay flaps had an increase in survival of 73 percent over control flaps, which was also statistically significant. There was no significant difference in survival between expanded flaps and delayed flaps. Morphologic studies using radiographic techniques on one pig demonstrated increased vascularity with tissue expansion. The results of this work demonstrate that in addition to providing increased surface area with controlled expansion, flaps raised in expanded skin have a significantly augmented surviving length. The mechanism for this increased vascularity with expansion is not known at this time, but it may be due to physical forces associated with expansion acting as a stimulus for angiogenesis.