Download PDF
Handchir Mikrochir Plast Chir 2014; 46(02): 74-79
DOI: 10.1055/s-0034-1367000
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Complications in Tissue Expansion: An Updated Retrospective Analysis of Risk Factors

Komplikationen in der Gewebeexpansion: Eine aktualisierte retrospektive Analyse der Risikofaktoren
J. Wang
1   Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
,
X. Huang
1   Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
,
K. Liu
1   Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
,
B. Gu
1   Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
,
Q. Li
1   Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
› Author Affiliations
Further Information

Publication History

received 27 December 2013

accepted 13 January 2014

Publication Date:
06 March 2014 (online)

Also available at
    Permissions and Reprints

Abstract

Background:

The technique of tissue expansion has been widely applied in plastic surgery since the 1980 s. Implantation in the lower limb region, external port placement, and young patient age were known as risk factors for complications. Over the years, surgical experience has increased along with improved patient management and expander manufacturing. The aim of this study was to identify possible changes in risk factors regarding complications in tissue expansion.

Method:

A retrospective, single-institution large sample observational study over a 5-year period (2006–2010) was performed involving 481 tissue expanders in 344 patients. Patients underwent surgical treatment for resurfacing scar tissue in the scalp, face, neck, nose, and limbs, but not breast. In addition, the results are discussed based on a comprehensive review of the literature published between 1995 and 2009.

Results:

Statistical analysis showed significant correlations between cheek and hematoma (P=0.0133), scalp and dehiscence (P=0.0139), number of expanders per region and leakage (P=0.0379), number of expanders per region and overall complications (P=0.0252). Factors such as gender, age, tobacco use, and repeated expander implantation had no significant influence on the incidence of complications. The lower extremity region and young patient age ceased to show a statistical correlation with complications. The number of expanders per region was identified as a risk factor that has been disregarded so far.

Conclusion:

Evidence suggests a recent change in risk factors for tissue expansion-related complications. Consideration of updated risk factors may help to further improve outcomes in tissue expansion.

Zusammenfassung

Hintergrund:

Die Technik der Gewebeexpansion findet seit den 1980er Jahren in der Plastischen Chirurgie breite Anwendung. Implantation in der unteren Extremitätenregion, externe Portplatzierung und junges Patientenalter sind als Risikofaktoren für Komplikationen bekannt. Mit dem Gewinn an chirurgischer Erfahrung sind im Laufe der Jahre auch Verbesserungen in Patientenmanagement und Expanderherstellung einhergegangen. Das Ziel dieser Studie war es, mögliche Veränderungen hinsichtlich Risikofaktoren für Komplikationen in der Gewebeexpansion zu identifizieren.

Methode:

In einer retrospektiven monozentrischen Beobachtungsstudie wurden über einen Zeitraum von 5 Jahren (2006–2010) 481 Gewebe­expander bei 344 Patienten untersucht. Die Patienten wurden wegen oberflächlicher Narben im Bereich von Skalp, Gesicht, Hals, Nase und Extremitäten exklusive Mammae chirurgisch behandelt. Des Weiteren wurde eine umfassende Literaturrecherche von Publikationen aus den Jahren 1995–2009 durchgeführt.

Ergebnisse:

Die statistische Analyse zeigte eine signifikante Korrelation zwischen Wange und Hämatom (P=0,0133), Skalp und Dehiszenz (P=0,0139), Anzahl der Expander pro Region und Leckage (P=0,0379) und Anzahl der Expander pro Region und Gesamtkomplikationen (P=0,0252). Faktoren wie Geschlecht, Alter, Tabakkonsum und wiederholte Expanderimplantation hatten keinen signifikanten Einfluss auf das Auftreten von Komplikationen. Die untere Extremitätenregion und junges Patientenalter wies keine statistische Korrelation mit Komplikationen mehr auf. Die Anzahl der Expander pro Region konnte als Risikofaktor identifiziert werden, der bislang nicht berücksichtigt wurde.

Zusammenfassung:

Die Resultate der vorliegenden Studie deuten auf veränderte Risikofaktoren für Komplikationen bei Gewebeexpansion hin. Die Berücksichtigung dieser aktuellen Risikofaktoren kann dazu beitragen, die Ergebnisse in der Gewebeexpansion weiter zu verbessern.

Key words

tissue expansion - complications - risk factors - reconstruction - expander

Schlüsselwörter

Gewebeexpansion - Komplikationen - Risikofaktoren - Rekonstruktion - Expander
 

  • References

  • 1 Radovan C. Breast reconstruction after mastectomy using the temporary expander. Plas Recon Surg 1982; 69: 195-208
    CrossrefPubMedGoogle Scholar
  • 2 Patel PA, Elhadi HM, Kitzmiller WJ, Billmire DA, Yakuboff KP. Tissue expander complications in the pediatric burn patient: a 10-year follow-up. Ann Plas Surg 2014; 72: 150-154
    CrossrefPubMedGoogle Scholar
  • 3 Huang X, Qu X, Li Q. Risk factors for complications of tissue expansion: a 20-year systematic review and meta-analysis. Plas Recon Surg 2011; 128: 787-797
    CrossrefPubMedGoogle Scholar
  • 4 Youm T, Margiotta M, Kasabian A, Karp N. Complications of tissue expansion in a public hospital. Ann Plas Surg 1999; 42: 396-401 discussion 401–392
    CrossrefPubMedGoogle Scholar
  • 5 Hallock GG. Safety of clinical overinflation of tissue expanders. Plas Recon Surg 1995; 96: 153-157
    CrossrefPubMedGoogle Scholar
  • 6 Friedman RM, Ingram Jr. AE, Rohrich RJ et al. Risk factors for complications in pediatric tissue expansion. Plas Recon Surg 1996; 98: 1242-1246
    CrossrefPubMedGoogle Scholar
  • 7 Vogelin E, de Roche R, Luscher NJ. Is soft tissue expansion in lower limb reconstruction a legitimate option?. Br J Plas Surg 1995; 48: 579-582
    CrossrefPubMedGoogle Scholar
  • 8 Adler N, Dorafshar AH, Bauer BS, Hoadley S, Tournell M. Tissue expander infections in pediatric patients: management and outcomes. Plas Recon Surg 2009; 124: 484-489
    CrossrefPubMedGoogle Scholar
  • 9 Cunha MS, Nakamoto HA, Herson MR et al. Tissue expander complications in plastic surgery: a 10-year experience. Rev Hosp Clin 2002; 57: 93-97
    PubMedGoogle Scholar
  • 10 Hudson DA, Grob M. Optimising results with tissue expansion: 10 simple rules for successful tissue expander insertion. Burns: J Int Soc Burn Inj. 2005. 31. 1-4
    Google Scholar
  • 11 Chun JT, Rohrich RJ. Versatility of tissue expansion in head and neck burn reconstruction. Ann Plas Surg 1998; 41: 11-16
    CrossrefPubMedGoogle Scholar
  • 12 Keskin M, Kelly CP, Yavuzer R, Miyawaki T, Jackson IT. External filling ports in tissue expansion: confirming their safety and convenience. Plas Recon Surg 2006; 117: 1543-1551
    CrossrefPubMedGoogle Scholar
  • 13 Lozano S, Drucker M. Use of tissue expanders with external ports. Ann Plas Surg 2000; 44: 14-17
    CrossrefPubMedGoogle Scholar
  • 14 Hamza F, Lantieri LA, Collins ED, Raulo Y. A new external filling device in tissue expansion. Plas Recon Surg 1998; 101: 813-815
    CrossrefPubMedGoogle Scholar
  • 15 Hudson DA, Arasteh E. Serial tissue expansion for reconstruction of burns of the head and neck. Burns: J Int Soc Burn Inj 2001; 27: 481-487
    CrossrefPubMedGoogle Scholar
  • 16 Gibstein LA, Abramson DL, Bartlett RA et al. Tissue expansion in children: a retrospective study of complications. Ann Plas Surg 1997; 38: 358-364
    CrossrefPubMedGoogle Scholar
  • 17 Pandya AN, Vadodaria S, Coleman DJ. Tissue expansion in the limbs: a comparative analysis of limb and non-limb sites. Br J Plas Surg 2002; 55: 302-306
    CrossrefPubMedGoogle Scholar
  • 18 Casanova D, Bali D, Bardot J, Legre R, Magalon G. Tissue expansion of the lower limb: complications in a cohort of 103 cases. Br J Plas Surg 2001; 54: 310-316
    CrossrefPubMedGoogle Scholar
  • 19 Jackson IT, Sharpe DT, Polley J, Costanzo C, Rosenberg L. Use of external reservoirs in tissue expansion. Plas Recon Surg 1987; 80: 266-273
    CrossrefPubMedGoogle Scholar
  • 20 Hurvitz KA, Rosen H, Meara JG. Pediatric cervicofacial tissue expansion. Int J Ped Otorhinolaryngol 2005; 69: 1509-1513
    CrossrefPubMedGoogle Scholar
  • 21 Bozkurt A, Groger A, O’Dey D et al. Retrospective analysis of tissue expansion in reconstructive burn surgery: evaluation of complication rates. Burns: J Int Soc Burn Inj. 2008. 34. 1113-1118
    Google Scholar
  • 22 Pisarski GP, Mertens D, Warden GD, Neale HW. Tissue expander complications in the pediatric burn patient. Plas Recon Surg 1998; 102: 1008-1012
    CrossrefPubMedGoogle Scholar
  • 23 Hawary MB. Tissue expansion: King Khalid University experience. Ann Saudi Med 1998; 18: 454-456
    PubMedGoogle Scholar
  • 24 Pitanguy I, Gontijo de Amorim NF, Radwanski HN, Lintz JE. Repeated expansion in burn sequela. Burns: J Int Soc Burn Inj 2002; 28: 494-499
    CrossrefPubMedGoogle Scholar
  • 25 Tavares Filho JM, Belerique M, Franco D, Porchat CA, Franco T. Tissue expansion in burn sequelae repair. Burns: J Int Soc Burn Inj 2007; 33: 246-251
    CrossrefPubMedGoogle Scholar