Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
J Plast Reconstr Aesthet Surg. 2024 Apr;91:119-127. doi: 10.1016/j.bjps.2024.01.050. Epub 2024 Feb 1.
Haematoma is an early complication of tissue expander placement and can lead to infection, capsule contracture and various complications, hindering successful reconstruction. However, no scientific models can accurately predict the risk of haematoma following tissue expansion. Therefore, this study aimed to develop and validate a prediction model for haematoma following tissue expander placement. The medical records of patients who underwent expander placement between 2001 and 2021 were obtained from the clinical database of the Department of Plastic Surgery at the Xijing Hospital. A total of 4579 consecutive patients with 7080 expanders and 179 expanded pocket haematomas were analysed. Multivariate logistic regression analysis identified adult age (P = 0.006), male sex (P < 0.001), scar reconstruction (P = 0.019), perioperative hypertension (P < 0.001), face and neck location (P = 0.002) and activated partial thromboplastin time above the normal range (P < 0.001) as risk factors for haematoma. Therefore, these were included in the prediction model, and a nomogram was constructed. The discrimination of the nomogram was robust (area under the curve: 0.78; 95% confidence interval: 0.72-0.83). Further, the prediction model had a strong fit (Hosmer-Lemeshow test, P = 0.066) and maintained similar discrimination after considering performance optimism (bootstrapped area under the curve: 0.79; 95% confidence interval: 0.73-0.84). This clinical prediction model was created using a generalisable dataset and can be utilised to obtain valid haematoma predictions after expander placement, assisting surgeons in implementing preventive measures or interventions to reduce the occurrence of haematoma.
血肿是组织扩张器放置的早期并发症，可导致感染、包膜挛缩和各种并发症，从而阻碍成功的重建。然而，目前尚无科学模型可以准确预测组织扩张后血肿的风险。因此，本研究旨在开发和验证组织扩张器放置后血肿的预测模型。从西京医院整形外科临床数据库中获取了 2001 年至 2021 年期间接受扩张器放置的患者的病历。共分析了 4579 例连续患者的 7080 个扩张器和 179 个扩张袋血肿。多变量逻辑回归分析确定成人年龄（P=0.006）、男性（P<0.001）、瘢痕重建（P=0.019）、围手术期高血压（P<0.001）、面颈部位置（P=0.002）和活化部分凝血活酶时间高于正常范围（P<0.001）是血肿的危险因素。因此，这些因素被纳入预测模型，并构建了一个列线图。该列线图的判别能力较强（曲线下面积：0.78；95%置信区间：0.72-0.83）。此外，该预测模型拟合度较好（Hosmer-Lemeshow 检验，P=0.066），在考虑性能乐观性后，其判别能力保持不变（Bootstrapped 曲线下面积：0.79；95%置信区间：0.73-0.84）。该临床预测模型是使用可推广的数据集创建的，可以用于获得扩张器放置后血肿的有效预测，帮助外科医生采取预防措施或干预措施，减少血肿的发生。
