Wang J, Huang X, Liu K, Gu B, Li Q
Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Handchir Mikrochir Plast Chir. 2014 Apr;46(2):74-9. doi: 10.1055/s-0034-1367000. Epub 2014 Mar 6.
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.
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.
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.
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.
自20世纪80年代以来，组织扩张技术已在整形外科中广泛应用。下肢区域植入、外置端口放置和患者年龄较小被认为是并发症的危险因素。多年来，随着患者管理和扩张器制造的改进，手术经验不断增加。本研究的目的是确定组织扩张并发症危险因素的可能变化。
进行了一项回顾性、单机构的5年大样本观察性研究（2006 - 2010年），涉及344例患者的481个组织扩张器。患者接受手术治疗以修复头皮、面部、颈部、鼻子和四肢（但不包括乳房）的瘢痕组织。此外，还基于对1995年至2009年发表的文献的全面综述对结果进行了讨论。
统计分析显示脸颊与血肿之间存在显著相关性（P = 0.0133），头皮与裂开之间存在显著相关性（P = 0.0139），每个区域扩张器的数量与渗漏之间存在显著相关性（P = 0.0379），每个区域扩张器的数量与总体并发症之间存在显著相关性（P = 0.0252）。性别、年龄、吸烟和重复扩张器植入等因素对并发症发生率没有显著影响。下肢区域和年轻患者年龄与并发症不再显示出统计学相关性。每个区域扩张器的数量被确定为一个迄今为止被忽视的危险因素。
有证据表明组织扩张相关并发症的危险因素最近发生了变化。考虑更新后的危险因素可能有助于进一步改善组织扩张的效果。
