Ann Arbor, Mich. From the Section of Plastic and Reconstructive Surgery and the Department of Surgery, University of Michigan Health System.
Plast Reconstr Surg. 2010 Feb;125(2):547-556. doi: 10.1097/PRS.0b013e3181c91d27.
Tissue expansion is not widely accepted for reconstruction of breast and chest burn deformities because of concerns about the capacity of compromised skin to stretch without complications. The authors hypothesized that tissue expander reconstruction of breast and chest burn deformities is reliable and has outcomes similar to those of expansion of similar nonburned tissues. The authors used congenital breast anomalies as a control because they share similar reconstructive challenges: constricted skin envelope and gross malformation of the parenchyma and nipple-areola complex. The authors also hypothesized that endoscopic techniques may improve outcomes for breast and chest burn reconstruction.
A retrospective review was completed of tissue expander reconstructions of burn and congenital breast deformities. All reconstructions used an endoscopic or open tissue expander placement and subsequent local tissue rearrangements. Data were analyzed using parametric and nonparametric methods.
For reconstruction of burn deformities, 15 women had 37 expanders placed. Within the congenital breast cohort, 20 patients had 22 tissue expanders placed. There were no statistical differences in follow-up time, body mass index, or comorbidities between burn and congenital patients. There was no statistical difference in major complications (p = 0.72) between these groups. Within the burn deformity cohort, endoscopic reconstructions had fewer major complications (p = 0.04), required less operative time per expander (p < 0.001), and required less time to expand (p = 0.021).
The authors believe that breast and chest burn deformities can be safely reconstructed with tissue expanders without increased complications over expander reconstruction of the congenital breast. Furthermore, endoscopic techniques may be superior for burn deformities because of improved visualization and remote incisions.
由于担心受损皮肤在没有并发症的情况下伸展的能力，组织扩张术在乳房和胸部烧伤畸形的重建中并未得到广泛接受。作者假设，组织扩张器重建乳房和胸部烧伤畸形是可靠的，并且其结果与类似非烧伤组织的扩张相似。作者使用先天性乳房畸形作为对照，因为它们具有相似的重建挑战：皮肤包裹受限以及实质和乳头乳晕复合体的严重畸形。作者还假设内窥镜技术可能会改善乳房和胸部烧伤重建的结果。
作者对烧伤和先天性乳房畸形的组织扩张器重建进行了回顾性研究。所有重建均使用内窥镜或开放式组织扩张器放置和随后的局部组织重新排列。使用参数和非参数方法分析数据。
在烧伤畸形重建中，15 名女性接受了 37 个扩张器的放置。在先天性乳房队列中，20 名患者接受了 22 个组织扩张器的放置。烧伤和先天性患者之间的随访时间、体重指数或合并症没有统计学差异。两组之间的主要并发症（p=0.72）无统计学差异。在烧伤畸形队列中，内窥镜重建的主要并发症较少（p=0.04），每个扩张器所需的手术时间更少（p<0.001），扩张时间更短（p=0.021）。
作者认为，乳房和胸部烧伤畸形可以使用组织扩张器安全重建，而不会增加扩张器重建先天性乳房的并发症。此外，内窥镜技术可能优于烧伤畸形，因为它具有更好的可视化和远程切口。
