European Journal of Plastic Surgery

, Volume 26, Issue 6, pp 306–311 | Cite as

Subperiosteal tissue expansion: an experimental study

  • Ibrahim AskarEmail author
  • Bizden Tavil Sabuncuoglu
  • Mustafa Rıza Ozbek
Original Article


Periosteal flaps have been used to cover bone defects. There are no sufficient data on whether expanded periosteum can be used to repair bone defects after subperiosteal tissue expansion. In this experimental study, 14 male dogs, which were 2 years-old and weighed 14.5–16.0 kg, were used to investigate the repair of bony defects with expanded periosteum. Rectangular tissue expanders, measuring 50 mm in width, 70 mm in length, and 20 mm in height (volume: 20 ml) were used. The dogs were divided into two groups each of seven dogs: one control group and one experimental group. In each dog, a pocket, 50×70 mm in size, was prepared in parietal area, and a periosteal area, 30×40 mm in size, was marked out. A rectangular tissue expander was inserted into the pocket. In the control group, the tissue expanders were not inflated. On the seventh postoperative day, the tissue expander inflation with normal saline (5 ml per 2 days) was started in the experimental group. After 15 days, the previously marked out periosteal area was measured. A specimen was taken from this periosteal tissue for histopathological evaluation. A bone defect, 20×20 mm in size, was created beneath expanded periosteal tissue, and this defect was covered with the expanded periosteal tissue. After 15 days, a histopathological evaluation was carried out. Statistical analysis was carried out using the Mann–Whitney U-test. The area of periosteum expanded was more in the experimental group than that of the control group (p>0.05). After removal of the tissue expander, both in the control and subperiosteal tissue expansion group, osteoblastic lining of the expanded periosteum, increased vascularity, and granulation tissue was noted. Following 15 days, woven and lamellated bone tissue was formed both in the control and subperiosteal expansion group. In the subperiosteal expansion group, there was greater bone formation, the expanded periosteum was thickened, and thickened lamellated bone was covered by active osteoblasts. It is concluded that subperiosteal tissue expansion may be worthwhile to provide large periosteal flaps for the repair of large bone defects, by increasing osteogenic capacity.


Periosteum Subperiosteal tissue expansion Tissue expander Bone defect 


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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Ibrahim Askar
    • 1
    Email author
  • Bizden Tavil Sabuncuoglu
    • 2
  • Mustafa Rıza Ozbek
    • 3
  1. 1.Plastic and Reconstructive SurgeryDicle University Medical SchoolDiyarbakirTurkey
  2. 2.Histology and EmbryologyAnkara University Medical SchoolAnkaraTurkey
  3. 3.Plastic and Reconstructive SurgeryAnkara University Medical SchoolAnkaraTurkey

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