University of Michigan Health System, Department of Surgery, Section of Plastic Surgery, Ann Arbor, Michigan.
Semin Plast Surg. 2008 Feb;22(1):9-17. doi: 10.1055/s-2007-1019137.
Plastic surgeons are frequently faced with difficult and challenging soft tissue defects in all areas of the body. To reconstruct these defects, there are many operative approaches available to the reconstructive surgeon including skin grafts, local flaps, regional flaps, and free-tissue transfer. Despite these many options, occasionally the best alternative for reconstruction of a wound is tissue expansion, where skin of similar quality, texture, and color can be used to close a soft tissue defect. Unfortunately, there are significant problems related to tissue expander reconstruction including a complication rate as high as 50%. As a result, tissue expander reconstruction has not achieved the widespread popularity commensurate with its potential clinical utility. To reduce the complication rate related to open tissue expander placement, and consequently to improve its clinical utility, we have employed endoscopic techniques for the placement of tissue expanders. Endoscopic approaches are currently being used in many areas of surgery and have resulted in substantial benefits. Endoscopic placement of tissue expanders has the benefit of reducing operative time, major complication rate, time to full expansion, and length of hospital stay. The purpose of this article is to critically examine the current open technique for tissue expander placement and to compare this technique with minimally invasive endoscopic tissue expander placement. We will discuss in detail the current problems associated with open tissue expander placement, the benefits of endoscopic tissue expansion, the technique of endoscopic tissue expander placement, and the outcomes for these techniques.
整形外科医生经常面临身体各部位的困难和具有挑战性的软组织缺损。为了重建这些缺损，重建外科医生有许多手术方法可供选择，包括皮片移植、局部皮瓣、区域性皮瓣和游离组织转移。尽管有许多选择，但对于伤口重建来说，有时最好的替代方法是组织扩张，其中可以使用质量、质地和颜色相似的皮肤来闭合软组织缺损。不幸的是，组织扩张器重建存在显著问题，包括高达 50%的并发症发生率。因此，组织扩张器重建并没有达到与其潜在临床应用相当的广泛普及。为了降低与开放式组织扩张器放置相关的并发症发生率，从而提高其临床应用效果，我们已经采用了内镜技术来放置组织扩张器。内镜技术目前正在许多外科领域中使用，并带来了显著的益处。内镜下放置组织扩张器具有缩短手术时间、降低主要并发症发生率、完全扩张时间和住院时间的优点。本文的目的是批判性地检查目前用于组织扩张器放置的开放式技术，并将其与微创内镜组织扩张器放置进行比较。我们将详细讨论开放式组织扩张器放置相关的当前问题、内镜组织扩张的益处、内镜组织扩张器放置技术以及这些技术的结果。
