Shanghai, People's Republic of China From the Departments of Plastic and Reconstructive Surgery and Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine.
Plast Reconstr Surg. 2011 Sep;128(3):787-797. doi: 10.1097/PRS.0b013e3182221372.
Tissue expansion is a widespread and accepted concept in plastic and reconstructive surgery and burn treatment but is also associated with a variety of complications. Most research does not reveal the risk factors for multiple complications of tissue expansion. To determine the risk factors for tissue expansion complications and to evaluate average complication rates, the authors performed a systematic review and meta-analysis of observational studies exploring risk factors for complications of tissue expansion.
The MEDLINE (1966 to August 2010), EMBASE (1980 to August of 2010), PreMEDLINE, and HealthSTAR databases were searched for articles published from January of 1970 through August of 2010. Supplemental searches were performed to include Internet resources and reference lists and by contacting experts in the field. Two reviewers extracted data independently. Data were combined using the Mantel-Haenszel method (random-effects models) and further analyzed by multiple regression.
Forty-two retrospective observational studies were included, yielding 5925 patients who underwent plastic and reconstructive surgery with tissue expansion. The total average complication rate was 17.44 percent, and the most common complication was infection (4.58 percent). The lower limb (with the exception of the breast) was more likely than other body sites to develop complications (odds ratio, 2.80; 95 percent confidence interval, 1.14 to 6.86), and the safest site at which to perform tissue expansion was the trunk (odds ratio, 0.78; 95 percent confidence interval, 0.45 to 1.33).
This systematic review and meta-analysis provides evidence that complications for tissue expansion are associated with specific risk factors, such as the site, the patient's smoking habits, and radiation therapy. The available data regarding average rates are also summarized.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
组织扩张在整形和重建外科以及烧伤治疗中是一种广泛接受的概念，但也伴随着各种并发症。大多数研究并未揭示组织扩张并发症的多种危险因素。为了确定组织扩张并发症的危险因素并评估平均并发症发生率，作者对探讨组织扩张并发症危险因素的观察性研究进行了系统评价和荟萃分析。
检索 MEDLINE（1966 年至 2010 年 8 月）、EMBASE（1980 年至 2010 年 8 月）、PreMEDLINE 和 HealthSTAR 数据库，查找 1970 年 1 月至 2010 年 8 月发表的文章。通过互联网资源和参考文献列表进行补充检索，并联系该领域的专家。两名评审员独立提取数据。使用 Mantel-Haenszel 法（随机效应模型）合并数据，并通过多元回归进行进一步分析。
纳入 42 项回顾性观察性研究，共计 5925 例行整形和重建外科组织扩张术的患者。总的平均并发症发生率为 17.44%，最常见的并发症是感染（4.58%）。下肢（乳房除外）比其他身体部位更容易发生并发症（比值比，2.80；95%置信区间，1.14 至 6.86），进行组织扩张最安全的部位是躯干（比值比，0.78；95%置信区间，0.45 至 1.33）。
本系统评价和荟萃分析提供的证据表明，组织扩张的并发症与特定的危险因素有关，如部位、患者的吸烟习惯和放射治疗。还总结了有关平均发生率的现有数据。
临床问题/证据水平：风险，II。
