Sonographic detection of a subcutaneous twisted expander injection port

Abstract

Tissue expanders (TEs) are widely used in plastic and reconstructive surgery. They can be used to induce new skin production in the treatment of burns and previous mastectomy. In these cases, an expandable balloon is positioned under the skin and gradually filled with fluid to facilitate stretching of the overlying skin and its development, necessary to implant a definite mammary prosthesis or for reconstructive purposes. Tissue expanders are also used in total pneumonectomy in which expansion of the contralateral lung can produce a severe dyspnea by compressing the main airways. A TE of the proper size and shape positioned inside the hemithorax compensates the pressure of the contralateral lung and relieves respiratory symptoms. Tissue expanders are composed of a subcutaneous self-sealing filling port in which the serum is injected, and the intrathoracic expander, a balloonlike bag, is connected by a flexible plastic tube. Complications include mechanical failure (port failure or malrotation, expander rupture, and perforation) as well as infections, hematoma, and suture dehiscence. We describe a case of twisting of the TE port diagnosed by sonography and comment on the usefulness of sonography in detecting this complication. © 2005 by the American Institute of Ultrasound in Medicine.