Reverse Tissue Expansion in Gastroschisis: What to do if the Defect is too large to close after Silo Removal?

Fadel M Chahine*; Bishara Atiyeh

Department of Surgery – Division of Plastic and reconstructive Surgery, American University of Beirut Medical Center

Correspondence: *. Correspondence: Fadel Chahine, Resident- Division of Plastic and Reconstructive Surgery – AUBMC, Lebanon. E-mail: E-mail:

Received: 2015 June 8; Accepted: 2015 June 25

J Neonat Surg. 2015 Jul 1; 4(3): 37


Copyright: © 2015 JNS

Dear Sir

We read with interest the case report by Adikibi and O'Toole [1] about what they have named “reverse tissue expansion” for the closure of a large gastroschisis defect. The authors must be commended for this highly ingenious technique that has enabled gradual stretching of the tissues with progressive reduction in the defect size without any damage to the skin edges. Unfortunately, what the authors are describing is not “reverse tissue expansion”. It is in fact stress-relaxation and mechanical creep, a well-established mechanism for skin stretching [2]. Instead of expanding the soft tissues to make available additional skin, we have described few years ago a technique specifically useful for scar revision. To avoid excising a scar then closing the wound primarily under tension, it is possible at sites rich in subcutaneous fat to deflate the tissues by liposuction to relax the skin envelope thus indirectly providing additional skin for scar revision or harvesting of full thickness skin grafts allowing relaxed wound closure. We have called this method “reverse tissue expansion” because in fact this is what it is. For scientific accuracy, we believe that the name “reverse tissue expansion” must be reserved to the technique we have described [3-5]. The authors must refer in describing their method of wound closure to what has already been reported in the literature.


Source of Support: Nil

Conflict of Interest: None

1. T Adikibi B, O'Toole S. Reverse tissue expansion in gastroschisis: what to do if the defect is too large to close after silo removal? J Neonatal Surg. 2014; 3:47.
2. Topaz M, Carmel NN, Topaz G, Li M, Li YZ. Stress-relaxation and tension relief system for immediate primary closure of large and huge soft tissue defects: an old-new concept: new concept for direct closure of large defects. Medicine. 2014; 93:e234.
3. Ibrahim A, Dibo S, Hayek S, Atiyeh B. Reverse tissue expansion by liposuction deflation for revision of post-surgical thigh scars. Int Wound J. 201; 8:622-31.
4. Atiyeh B, Costagliola M, Illouz YG, Dibo S, Zgheib E, Rampillon F. Functional and therapeutic indications of liposuction: personal experience and review of the literature. Ann Plast Surg. Accessed on 2015 Feb 18. [Epub ahead of print].
5. Ibrahim AE, Debbas CC, Dibo SA, Atiyeh BS, Abu-Sittah GS. Reverse tissue expansion by liposuction deflation adopted for harvest of large sheet of full-thickness skin graft. Ann Burns Fire Disasters. 2012; 25:98–101.


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