Difference between revisions of "Tissue expansion"

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'''Tissue expansion''' is a technique used by plastic, maxillofacial, and reconstructive surgeons to cause the body to grow additional skin, bone, or other tissues. Other biological phenomena such as tissue inflammation can also be considered expansion.
+
'''Tissue expansion''' is a technique used by plastic, maxillofacial, and reconstructive surgeons to cause the body to grow additional [[skin]], bone, or other tissues.<ref name="whyitworks2021">{{REFweb
 +
|url=https://www.phimostretch.com/blogs/news/phimosis-stretching-why-it-works
 +
|title=Phimosis -Why stretching totally works (Science explained) -Phimostretch
 +
|last=
 +
|first=
 +
|date=2021
 +
|accessdate=2021-07-28
 +
}}</ref> Other biological phenomena such as tissue inflammation can also be considered expansion.
  
−
==Skin expansion==
+
== Skin expansion ==
−
Skin expansion is a common surgical procedure to grow extra skin through controlled mechanical overstretch. It creates skin that matches the color, texture, and thickness of the surrounding tissue, while minimizing scars and risk of rejection.
 
  
−
When skin is stretched beyond its physiological limit, mechanotransduction pathways are activated. This leads to cell growth as well as to the formation of new cells.
+
[[Skin]] expansion is a common surgical procedure to grow additional [[skin]] through controlled mechanical overstretch.<ref name="whyitworks2021" /> It creates [[skin]] that matches the color, texture, and thickness of the surrounding tissue, while minimizing scars and eliminating risk of rejection.
  
−
The growth of tissue is permanent, but will retract to some degree when the tension is removed.
+
When [[skin]] is stretched beyond its physiological limit, mechanotransduction pathways are activated. This leads to cell growth as well as to the [[Mitosis| formation of new cells]].<ref name="whyitworks2021" />
 +
 
 +
The growth of tissue is permanent<ref>{{REFbook
 +
|last=Bigelow
 +
|first=Jim
 +
|init=J
 +
|author-link=Jim Bigelow
 +
|year=1995
 +
|title=[[The Joy of Uncircumcising]]
 +
|work=
 +
|editor=
 +
|edition=
 +
|volume=
 +
|chapter=Ch. 13: Skin expansion:How it works and what it provides
 +
|scope=
 +
|page=
 +
|pages=132-9
 +
|location=Aptos, California
 +
|publisher=Hourglass Book Publishing
 +
|ISBN=0-934061-22-X
 +
|quote=The gain in sensitivity is the first and most consistent benefit of restoration.
 +
|accessdate=2023-08-15
 +
|note=
 +
}}</ref>
  
 
=== Mechanics of skin expansion ===
 
=== Mechanics of skin expansion ===
−
Stretching the skin beyond normal expansion invokes several mechanotransduction pathways which increase [[mitosis| mitotic]] activity and promote collagen synthesis. As a result, the skin surface area increases.<ref>{{REFjournal
+
[[Stretching]] the [[skin]] beyond normal expansion invokes several mechanotransduction pathways which increase [[mitosis| mitotic]] activity and promote collagen synthesis.<ref name="whyitworks2021" /> As a result, the [[skin]] surface area increases.<ref>{{REFjournal
 
  |last=Zöllner  
 
  |last=Zöllner  
 
  |first=Alexander M.
 
  |first=Alexander M.
 +
|init=AM
 
  |author-link=
 
  |author-link=
 
  |last2=Tepole
 
  |last2=Tepole
−
  |first2=A.B.
+
  |init2=AB
 
  |last3=Kuhl
 
  |last3=Kuhl
−
  |first3=E.
+
  |init3=E
 
  |title=On the biomechanics and mechanobiology of growing skin
 
  |title=On the biomechanics and mechanobiology of growing skin
−
|trans-title=
 
−
|language=
 
 
  |journal=Theoretical Biology
 
  |journal=Theoretical Biology
 
  |date=2012
 
  |date=2012
Line 26: Line 54:
 
  |pages=166-75
 
  |pages=166-75
 
  |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278515/
 
  |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278515/
−
|quote=
 
 
  |pubmedID=3278515
 
  |pubmedID=3278515
 
  |pubmedCID=22227432
 
  |pubmedCID=22227432
Line 33: Line 60:
 
}}</ref>
 
}}</ref>
  
−
===Relief of phimosis or tight foreskin===
+
== Applications ==
−
Tissue expansion by manual stretching effectively widens the [[foreskin]] to treat [[phimosis]].<ref>{{REFjournal
+
 
 +
=== Relief of phimosis or tight foreskin ===
 +
 
 +
Tissue expansion by manual [[stretching]] effectively widens the [[foreskin]] to treat [[phimosis]] or [[paraphimosis]].<ref>{{REFjournal
 
  |last=Dunn
 
  |last=Dunn
−
  |first=HP
+
  |init=HP
 
  |author-link=
 
  |author-link=
 
  |etal=no
 
  |etal=no
−
  |title=
+
  |title=Non-Surgical Management of Phimosis
−
|trans-title=
 
−
|language=
 
 
  |journal=Aust N Z J Surg
 
  |journal=Aust N Z J Surg
 
  |location=
 
  |location=
Line 54: Line 82:
 
  |DOI=10.1111/j.1445-2197.1989.tb07640.x
 
  |DOI=10.1111/j.1445-2197.1989.tb07640.x
 
  |accessdate=2019-11-07
 
  |accessdate=2019-11-07
−
}}</ref> <ref>{{REFjournal
+
}}</ref> <ref name="beauge1991">{{REFdocument
 +
|title=Conservative Treatment of Primary Phimosis in Adolescents
 +
|url=http://www.cirp.org/library/treatment/phimosis/beauge/
 +
|contribution=
 
  |last=Beaugé
 
  |last=Beaugé
−
  |first=M.
+
  |first=Michel
 +
|publisher=Saint-Antoine University
 +
|format=
 +
|date=1991
 +
|accessdate=2022-11-20
 +
}}</ref> <ref name="beauge1997">{{REFjournal
 +
|last=Beaugé
 +
|init=M
 
  |title=The causes of adolescent phimosis
 
  |title=The causes of adolescent phimosis
 
  |journal=Br J Sex Med
 
  |journal=Br J Sex Med
Line 69: Line 107:
 
  |date=1997
 
  |date=1997
 
  |accessdate=2019-10-18
 
  |accessdate=2019-10-18
−
}}</ref>
+
}}</ref> One should continue to stretch until one's [[foreskin]] [[Gliding action| glides]] smoothly back and forth. This works best when topical steroid ointment (available by prescription) is used along with the stretching.
 +
 
 +
==== A word to [[intact]] teens ====
 +
 
 +
Boys are born with a [[foreskin]] that is non-retractable for reasons of protection. The inner surface is fused with the [[glans penis]] by a [[synechia]] (similar to a fingernail that is glued to the nail bed of the finger). Also the tip of the [[foreskin]] is too narrow to retract. As a boy gets older, the synechia disintegrates and releases the foreskin and the foreskin gets wider as a boy ages, so the foreskin gradually becomes [[Retraction of the foreskin|retractable]]. Some boys go through puberty but find that their [[foreskin]] is still too narrow to permit retraction.
 +
 
 +
Beaugé (1997) reported that boys, who [[Masturbation| masturbate]] by pulling their foreskin away from the body, will not stretch the tight part of the foreskin so non-retractile foreskin will persist. He advised changing the method of [[masturbation]] to the more conventional method of pulling the [[foreskin]] toward the body so that the narrow orifice get stretched.<ref name="beauge1997" />
 +
 
 +
The traditional way of addressing this issue was to consult a [[Issues with American urologists and the practice of male circumcision| urologist]] and get a [[Adolescent and adult circumcision| circumcision]], however we now understand that in the vast majority of cases, manual [[stretching]] over a few months will widen the [[foreskin]] by tissue expansion, make the foreskin retractable and eliminate the need for a destructive [[Adolescent and adult circumcision| circumcision]].
 +
 
 +
=== Foreskin restoration ===
  
−
===Foreskin restoration===
+
Tissue expansion has also been used for the technique of non-surgical [[foreskin restoration]], which applies tension externally using specialized devices and/or manual stretching to replace circumcised tissues with newly expanded residual [[shaft skin]].<ref>{{REFjournal
−
Tissue expansion has also been used for the technique of [[foreskin restoration]], which is usually non-surgical and applies tension externally using specialized devices to replace circumcised tissues with new cells.<ref>{{REFjournal
 
 
  |last=Radovan  
 
  |last=Radovan  
−
  |first=C.
+
  |init=C
 
  |author-link=
 
  |author-link=
 
  |title=Tissue expansion in soft-tissue reconstruction
 
  |title=Tissue expansion in soft-tissue reconstruction
Line 92: Line 139:
 
}}</ref>
 
}}</ref>
  
−
Non-surgical tissue expansion techniques can expand one's surviving penile skin, making it a longer tube so it can function like a [[foreskin]].<ref name="collier2011">{{REFjournal
+
Non-surgical tissue expansion techniques can expand one's surviving [[penile skin]], making it a longer tube so it can function like a [[foreskin]].<ref name="collier2011">{{REFjournal
 
  |last=Collier
 
  |last=Collier
 
  |first=Roger
 
  |first=Roger
 +
|init=R
 
  |author-link=
 
  |author-link=
 
  |title=Whole again: the practice of foreskin restoration
 
  |title=Whole again: the practice of foreskin restoration
Line 110: Line 158:
 
  |DOI=10.1503/cmaj.109-4009
 
  |DOI=10.1503/cmaj.109-4009
 
  |accessdate=
 
  |accessdate=
−
}}</ref> Men who have been circumcised stretch and apply tension to their shaft and foreskin remnants to expand and elongate tissue in efforts to produce a functional foreskin. This form of tissue expansion can take years, as the amount of skin growth required is typically around 15 square inches.<ref>{{REFweb
+
}}</ref> Men who have been [[circumcised]] stretch and apply tension to their shaft and foreskin remnants to expand and elongate tissue in efforts to produce a functional [[foreskin]]. This form of tissue expansion can take years, as the amount of [[skin]] growth required is typically around 15 square inches.<ref>{{REFweb
 
  |url=http://www.noharmm.org/snip.htm
 
  |url=http://www.noharmm.org/snip.htm
 
  |title=Not a "Snip," But 15 Square Inches
 
  |title=Not a "Snip," But 15 Square Inches
−
|trans-title=
 
−
|language=
 
 
  |last=Hammond
 
  |last=Hammond
−
  |first=T
+
  |first=Tim
 +
|init=T
 +
|author-link=Tim Hammond
 
  |publisher=
 
  |publisher=
−
  |website=NOHARMM
+
  |website=[[NOHARMM]]
 
  |date=2012-02-28
 
  |date=2012-02-28
 
  |accessdate=2019-10-10
 
  |accessdate=2019-10-10
−
|format=
+
}}</ref> This process does not regenerate or restore the function of the [[frenulum]] or the [[ridged band]]. It does, however, typically involve growing more [[shaft skin]] and [[preputial mucosa]], which serves to moisten and protect the [[glans penis|glans]]. Men who have restored their [[foreskin]] typically notice increased sensitivity and [[dekeratinization]] of the glans.<ref>{{REFweb
−
|quote=
 
−
}}</ref> This process does not regenerate or restore the function of the [[frenulum]] or the [[ridged band]]. It does, however, typically involve growing more shaft skin and [[preputial mucosa]], which serves to moisten and protect the [[glans penis|glans]]. Men who have restored their foreskin typically notice increased sensitivity and dekeratinization of the glans.<ref>{{REFweb
 
 
  |url=http://www.cirp.org/pages/restore.html
 
  |url=http://www.cirp.org/pages/restore.html
 
  |title=Foreskin restoration for circumcised men
 
  |title=Foreskin restoration for circumcised men
−
|trans-title=
+
  |publisher=[[CIRP]]
−
|language=
 
−
|last=
 
−
|first=
 
−
  |publisher=
 
−
|website=Circumcision Information and Resource Pages
 
 
  |date=2013-08-17
 
  |date=2013-08-17
 
  |accessdate=2019-10-10
 
  |accessdate=2019-10-10
−
|format=
+
}}</ref>
−
|quote=
+
 
−
}}</ref>  
+
==Lengthening one's foreskin==
 +
 
 +
There are several reasons a person would want to lengthen his existing [[foreskin]]. The longer the [[foreskin]] is, the more securely it will stay protectively in place over the [[glans penis]]. Many regard a longer foreskin or [[acroposthion]] as more esthetically pleasing. A longer foreskin provides better protection against [[keratinization]] than a shorter foreskin. A longer foreskin also allows a longer [[gliding action]] with better sensation than a shorter foreskin.
 +
 
 +
One uses the same techniques as are used for for non-surgical [[foreskin restoration]].
 +
 
 +
=== Excessive circumcision ===
 +
 
 +
Men who have been [[circumcised]] sometimes report that there is not enough [[skin]] left to allow full [[erection]] of the [[penis]], so the [[penis]] is shorter than before [[circumcision]]. They may also experience tight, painful [[erection]]s.  In such cases, tissue expansion may help to get full length and relieve pain during [[erection]].
 +
 
 +
=== Short natural foreskins ===
  
−
Men who have been circumcised sometimes report that there is not enough skin left to allow full erection of the penis, so the penis is shorter than before [[circumcision]].  In such cases, tissue expansion may help to get full erection.
+
[[Intact]] men who have a short natural [[foreskin]] may use tissue expansion to lengthen their [[foreskin]].  
  
−
{{SEEALSO}}
+
An [[acroposthion]] may be created gradually with consistent regular stretching with a device or manually.
  
−
* [[Retraction of the foreskin]]
+
=== Correction of an uneven foreskin ===
 +
Some foreskins are naturally shorter on one side than the other. This may be corrected over time by manually stretching only the short side.
  
 +
=== Retraining of a long retracted foreskin ===
 +
A few [[intact]] males will elect to wear their [[foreskin]] permanently retracted for months or years. Later, when they change their mind about the advisability of that practice, they find that their foreskin will not remain in its normal position where it covers and protects the [[glans penis]], because it seems to have become shorter. In such cases, it is necessary to provide traction on the [[foreskin]] to lengthen it to its normal length. The same techniques used by [[circumcised]] men, who are restoring their lost foreskin, works very well in such cases.
 +
{{SEEALSO}}
 +
* [[Basics of foreskin restoration]]
 +
* [[Foreskin restoration]]
 +
* [[Frenulum breve]]
 +
* [[Mitosis]]
 +
* [[Penis]]
 
* [[Phimosis]]
 
* [[Phimosis]]
 +
* [[Retraction of the foreskin]]
 +
* [[Stretching]]
 +
* [[Plastic surgery]]
  
 +
{{LINKS}}
 +
* {{REFweb
 +
|url=http://acroposthion.com/the-tip-at-the-end/
 +
|title=The ‘Tip’ At The End
 +
|publisher=Acroposthion
 +
|date=
 +
|accessdate=2023-01-15
 +
}}
 +
* {{REFjournal
 +
|last=Zöllner
 +
|first=Alexander
 +
|init=
 +
|author-link=
 +
|last2=Tepole
 +
|first2=Adrian Buganza
 +
|init2=
 +
|author2-link=
 +
|last3=Kuhl
 +
|first3=Ellen
 +
|init3=
 +
|author3-link=
 +
|etal=no
 +
|title=On the biomechanics and mechanobiology of growing skin
 +
|trans-title=
 +
|language=
 +
|journal= J Theor Biol.
 +
|location=
 +
|date=2012-03
 +
|season=
 +
|volume=296
 +
|issue=
 +
|article=
 +
|page=
 +
|pages=166-175
 +
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278515/
 +
|archived=
 +
|quote=
 +
|pubmedID=22227432
 +
|pubmedCID=3278515
 +
|DOI=10.1016/j.jtbi.2011.12.022
 +
|accessdate=2022-08-24
 +
}}
 +
* {{REFjournal
 +
|last=Razzak
 +
|first=
 +
|init=MA
 +
|author-link=
 +
|last2=Hossain
 +
|first2=
 +
|init2=MS
 +
|author2-link=
 +
|last3=Radz
 +
|first3=
 +
|init3=ZB
 +
|author3-link=
 +
|last4=Radz
 +
|first4=
 +
|init4=MA
 +
|author4-link=
 +
|last5=Czernuszka
 +
|first5=
 +
|init5=J
 +
|author5-link=
 +
|last6=Rahman
 +
|first6=
 +
|init6=MT
 +
|author6-link=
 +
|etal=no
 +
|title=Cellular and Molecular Responses to Mechanical Expansion of Tissue
 +
|trans-title=
 +
|language=
 +
|journal=Front. Physiol
 +
|location=
 +
|date=2016-11-15
 +
|season=
 +
|volume=7
 +
|issue=
 +
|article=
 +
|page=540
 +
|pages=
 +
|url=https://www.frontiersin.org/articles/10.3389/fphys.2016.00540/full
 +
|archived=
 +
|quote=
 +
|pubmedID=27899897
 +
|pubmedCID=5111402
 +
|DOI=10.3389/fphys.2016.00540. eCollection 201
 +
|accessdate=2022-08-20
 +
}}
 +
*  {{REFweb
 +
|url=http://phimosisjourney.com/
 +
|title=A Phimosis Journey
 +
|last=
 +
|first=
 +
|init=
 +
|publisher=
 +
|date=
 +
|accessdate=2023-12-24
 +
}}
 
{{REF}}
 
{{REF}}
 +
 +
 +
 +
[[Category:Education]]
 +
[[Category:Foreskin restoration]]
 +
[[Category:Physiology]]
 +
[[Category:Foreskin anatomy]]

Latest revision as of 16:58, 10 March 2024

Tissue expansion is a technique used by plastic, maxillofacial, and reconstructive surgeons to cause the body to grow additional skin, bone, or other tissues.[1] Other biological phenomena such as tissue inflammation can also be considered expansion.

Skin expansion

Skin expansion is a common surgical procedure to grow additional skin through controlled mechanical overstretch.[1] It creates skin that matches the color, texture, and thickness of the surrounding tissue, while minimizing scars and eliminating risk of rejection.

When skin is stretched beyond its physiological limit, mechanotransduction pathways are activated. This leads to cell growth as well as to the formation of new cells.[1]

The growth of tissue is permanent[2]

Mechanics of skin expansion

Stretching the skin beyond normal expansion invokes several mechanotransduction pathways which increase mitotic activity and promote collagen synthesis.[1] As a result, the skin surface area increases.[3]

Applications

Relief of phimosis or tight foreskin

Tissue expansion by manual stretching effectively widens the foreskin to treat phimosis or paraphimosis.[4] [5] [6] One should continue to stretch until one's foreskin glides smoothly back and forth. This works best when topical steroid ointment (available by prescription) is used along with the stretching.

A word to intact teens

Boys are born with a foreskin that is non-retractable for reasons of protection. The inner surface is fused with the glans penis by a synechia (similar to a fingernail that is glued to the nail bed of the finger). Also the tip of the foreskin is too narrow to retract. As a boy gets older, the synechia disintegrates and releases the foreskin and the foreskin gets wider as a boy ages, so the foreskin gradually becomes retractable. Some boys go through puberty but find that their foreskin is still too narrow to permit retraction.

Beaugé (1997) reported that boys, who masturbate by pulling their foreskin away from the body, will not stretch the tight part of the foreskin so non-retractile foreskin will persist. He advised changing the method of masturbation to the more conventional method of pulling the foreskin toward the body so that the narrow orifice get stretched.[6]

The traditional way of addressing this issue was to consult a urologist and get a circumcision, however we now understand that in the vast majority of cases, manual stretching over a few months will widen the foreskin by tissue expansion, make the foreskin retractable and eliminate the need for a destructive circumcision.

Foreskin restoration

Tissue expansion has also been used for the technique of non-surgical foreskin restoration, which applies tension externally using specialized devices and/or manual stretching to replace circumcised tissues with newly expanded residual shaft skin.[7]

Non-surgical tissue expansion techniques can expand one's surviving penile skin, making it a longer tube so it can function like a foreskin.[8] Men who have been circumcised stretch and apply tension to their shaft and foreskin remnants to expand and elongate tissue in efforts to produce a functional foreskin. This form of tissue expansion can take years, as the amount of skin growth required is typically around 15 square inches.[9] This process does not regenerate or restore the function of the frenulum or the ridged band. It does, however, typically involve growing more shaft skin and preputial mucosa, which serves to moisten and protect the glans. Men who have restored their foreskin typically notice increased sensitivity and dekeratinization of the glans.[10]

Lengthening one's foreskin

There are several reasons a person would want to lengthen his existing foreskin. The longer the foreskin is, the more securely it will stay protectively in place over the glans penis. Many regard a longer foreskin or acroposthion as more esthetically pleasing. A longer foreskin provides better protection against keratinization than a shorter foreskin. A longer foreskin also allows a longer gliding action with better sensation than a shorter foreskin.

One uses the same techniques as are used for for non-surgical foreskin restoration.

Excessive circumcision

Men who have been circumcised sometimes report that there is not enough skin left to allow full erection of the penis, so the penis is shorter than before circumcision. They may also experience tight, painful erections. In such cases, tissue expansion may help to get full length and relieve pain during erection.

Short natural foreskins

Intact men who have a short natural foreskin may use tissue expansion to lengthen their foreskin.

An acroposthion may be created gradually with consistent regular stretching with a device or manually.

Correction of an uneven foreskin

Some foreskins are naturally shorter on one side than the other. This may be corrected over time by manually stretching only the short side.

Retraining of a long retracted foreskin

A few intact males will elect to wear their foreskin permanently retracted for months or years. Later, when they change their mind about the advisability of that practice, they find that their foreskin will not remain in its normal position where it covers and protects the glans penis, because it seems to have become shorter. In such cases, it is necessary to provide traction on the foreskin to lengthen it to its normal length. The same techniques used by circumcised men, who are restoring their lost foreskin, works very well in such cases.

See also

External links

References

  1. ↑ a b c d REFweb (2021). Phimosis -Why stretching totally works (Science explained) -Phimostretch. Retrieved 28 July 2021.
  2. ↑ REFbook Bigelow J (1995): Ch. 13: Skin expansion:How it works and what it provides, in: The Joy of Uncircumcising. Aptos, California: Hourglass Book Publishing. Pp. 132-9. ISBN 0-934061-22-X. Retrieved 15 August 2023.
    Quote: The gain in sensitivity is the first and most consistent benefit of restoration.
  3. ↑ REFjournal Zöllner AM, Tepole AB, Kuhl E. On the biomechanics and mechanobiology of growing skin. Theoretical Biology. 2012; 297: 166-75. PMID. PMC. DOI. Retrieved 10 October 2019.
  4. ↑ REFjournal Dunn HP. Non-Surgical Management of Phimosis. Aust N Z J Surg. 1989; 59(12): 1963. PMID. DOI. Retrieved 7 November 2019.
  5. ↑ REFdocument Beaugé, Michel: Conservative Treatment of Primary Phimosis in Adolescents, Saint-Antoine University. (1991). Retrieved 20 November 2022.
  6. ↑ a b REFjournal Beaugé M. The causes of adolescent phimosis. Br J Sex Med. 1997; (Sept/Oct): 26. Retrieved 18 October 2019.
  7. ↑ REFjournal Radovan C. Tissue expansion in soft-tissue reconstruction. Plastic and Reconstructive Surgery. 1984; 74(4) PMID. DOI. Retrieved 10 October 2019.
  8. ↑ REFjournal Collier R. Whole again: the practice of foreskin restoration. CMAJ. 2011; 183(18): 2092-3. PMID. PMC. DOI.
  9. ↑ REFweb Hammond T (28 February 2012). Not a "Snip," But 15 Square Inches, NOHARMM. Retrieved 10 October 2019.
  10. ↑ REFweb (17 August 2013). Foreskin restoration for circumcised men, CIRP. Retrieved 10 October 2019.
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