Tissue expanders are inflated by plastic surgeons to stretch the skin. This is either to allow something to be placed underneath the skin such as a false breast after mastectomy, or to stretch the skin to cover a wider area.
For children with burns, they frequently lose hair roots on part of the head. By inflating a sort of sack or balloon beneath the remaining good hair, it can be stretched and eventually cut and stitched into position, so that the skin with hair roots covers the whole scalp.
This does not make more hair. It redistributes the same amount of hair over a wider area - a bit like the difference between a lush lawn and scrubland. Nonetheless, it can look very good once it is completed.
If there is not a lot of hair left after the child has been injured, it may not be worth the cost and discomfort of carrying out the procedure.
Sometimes there is other damage to the skull or scalp that also makes it unlikely that the procedure will work. A child may have a bony deficit (i.e. a hole) under the skin after burns. This can be a problem for tissue expanders. There can also be a problem is such a hole has subsequently ossified - filled up with lumpy bone some time after the injury. A tissue expander can only be used on the scalp if there is underlying bone.
The tissue expander has a valve. The expander is inflated by injecting in sterile saline solution, typically once a week. The amount of saline added each time is determined by discolouration of the skin at the edges, as the liquid is added - and also by the amount of pain or discomfort that the child can bear.
Agnes Mohasa (pictured), age 12, whose scalp was expanded with injections of saline into a tissue expander. Including failed valves and damaged expanders, it took over a year to get the process right. She hopes to have a more normal hairline by July 2001. Mfundo Ntamehlo is undergoing the same process, at about 50 millilitres of saline injected each week, at Milpark Hospital, Johannesburg.
In the weeks / months in which the child is using a tissue expander, their head is a very strange shape and they can be subject to ridicule if their schoolmates don't have the concept explained in advance. The tissue expanders can leak. And the skin should not be knocked while they are in place.
Some hospitals use second hand tissue expanders.
Too many parents take their children out of school while the expanders are being used, typically putting the child a year behind her peers.
No tissue expanders are made in South Africa. Three companies that make the devices are called Laborataire Euro Silicone (France); Mentor (USA) and McGann (USA). Johannesburg-based Conquest Medical imports the French ones into South Africa. They were selling for R2166 (including VAT and valve) but the price rose on Feb 1st to R2451. It is important to know the price as the charity has received allegations of one medical worker inflating the price to a poor family by an additional R1900.
The devices are bought regularly by the Red Cross Hospital and Groete Schoer in Cape Town and sporadically by Wentworth (Durban); Chris Hani Baragwanath (Soweto) and rarely by Johannesburg General Hospital.
All these hospitals used to use a lot more tissue expanders.
Now surgeons in private practice are the main customers and their tissue expanders are mostly acquired to use for breast reconstruction.
Children who have been assisted by the Charity in some capacity and who have benefited from tissue expanders include Mfundo Ntamehlo, Lesedi Moila, Samkelo and Agnes Mohasa. Oscar Hadebe, age 7, will have tissue expanders used over his stomach area to produce more skin to improve the severe keloiding of his face, around July 2001. His mother was convinced that tissue expanders would damage his ability to digest food so it is important that medical staff explain the method, with pictures, to both child and parent, to minimise anxiety. Mfundo's mother too was scared of the concept and took her son to see a traditional healer - who then told her that Mfundo would die if anything was put under his skin. When Mfundo understood the concept, he managed to explain it to his mother and to allay her fears.
The series of photos below show the tissue expansion work that is currently being performed on Mfundo Ntamehlo.
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