From the Division of Plastic and Reconstructive Surgery, Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine; the Division of Plastic and Reconstructive Surgery, University of Florida; and the Department of Plastic Surgery, Medical College of Wisconsin.
Plast Reconstr Surg. 2018 Sep;142(3):759-768. doi: 10.1097/PRS.0000000000004650.
Tissue expansion, while a mainstay of reconstruction for pediatric cutaneous lesions, has significant complication rates. The authors review the complications in a single-surgeon series of tissue expansion to identify risk factors for complications and guide subsequent therapy so that reconstructive goals in patients can be met irrespective of intervening complications.
A retrospective chart review was conducted of all pediatric patients who underwent tissue expansion performed by the senior author (A.K.G.) over a 12-year period. In total, 282 expanders were placed in 94 patients.
A total of 65 complications occurred in 39 of 94 patients (41.5 percent), involving 65 of the 282 expanders (23.0 percent) placed. Major complications that required expander removal included exposure (n = 11), rupture (n = 15), and migration (n = 11). The most frequent minor complications, which did not require immediate expander removal, included migration (n = 13) and port malfunction (n = 9). The majority of expanders were placed in the scalp (n = 114), followed by the torso (n = 100), face and neck (n = 52), and the extremities (n = 16). Serial expansion beyond the second round resulted in a marked increase in complications. Despite complications, tissue expansion in the majority of patients could be salvaged, and a satisfactory outcome was achieved.
Families must be made aware that approximately one-third of patients may have a complication requiring additional surgery or modification of the initial reconstructive plan. However, these complications need not preclude attainment of reconstructive goals.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
组织扩张术是小儿皮肤病变重建的主要方法，但并发症发生率较高。作者回顾了一位外科医生进行的组织扩张术的单一系列并发症，以确定并发症的危险因素，并指导后续治疗，从而使患者无论是否存在干预性并发症，都能达到重建目标。
对在过去 12 年内由资深作者（A.K.G.）进行的组织扩张术的所有小儿患者进行回顾性图表审查。总共在 94 名患者中放置了 282 个扩张器。
在 94 名患者中的 39 名（41.5%）患者中发生了 65 例并发症，涉及放置的 282 个扩张器中的 65 个（23.0%）。需要去除扩张器的主要并发症包括暴露（n=11）、破裂（n=15）和迁移（n=11）。不需要立即去除扩张器的最常见的轻微并发症包括迁移（n=13）和端口故障（n=9）。大多数扩张器放置在头皮（n=114），其次是躯干（n=100）、面部和颈部（n=52）以及四肢（n=16）。在第二轮之后进行连续扩张会显著增加并发症的发生。尽管存在并发症，但大多数患者的组织扩张仍可挽救，且获得了满意的结果。
必须让患者家属意识到，大约三分之一的患者可能会出现需要额外手术或修改初始重建计划的并发症。然而，这些并发症不应妨碍达到重建目标。
临床问题/证据水平：治疗，IV。
