Pisarski G P, Mertens D, Warden G D, Neale H W
Department of Surgery, University of Cincinnati College of Medicine and the Shriners Burns Institute-Cincinnati Unit, Ohio, USA.
Plast Reconstr Surg. 1998 Sep;102(4):1008-12. doi: 10.1097/00006534-199809040-00012.
Tissue expanders have become a useful adjuvant in pediatric burn reconstruction. We reviewed our experience with tissue expanders from June of 1984 to July of 1995. There were 403 expanders used in 301 patients. Complications relative to specific anatomic areas from July of 1987 to July of 1995 were compared with previously published data in the journal from June of 1984 to June of 1987. Complications were defined as absolute if they resulted in the loss of expanders or in additional surgery, or none of the preoperative plan was satisfied. The relative complications were defined as spotty alopecia, alopecia greater than 50 percent, or the operative plan was only partially satisfied, sometimes implying poor surgical judgment. The overall complication rate for the period June of 1984 to June of 1987 was 30 percent (37 complications in 122 expanders). In the July of 1987 to July of 1995 study, the complication rate was only 18 percent (51 complications in 281 expanders). This was a statistically significant decrease between the periods (p = 0.010). In the recent 8-year period, there was a decrease compared with the previous study in both the absolute and relative complications. The most common absolute complication in this period was infection (15 of 31, 48 percent) with 12 (39 percent) being early infection. With regard to the nine complications in the neck, face, ear, and supraclavicular area, two-thirds were related to leakage or exposure of the expanders, resulting from the tight anatomic area causing mechanical damage of the expanders as well as ischemia to the overlying skin. Early in the study, the lower extremities proved to involve difficult or unsatisfactory areas to expand, and lower extremity expansion was abandoned throughout the remainder of the study period. The overall decrease in absolute and relative complications is likely the result of increased operative experience as well as a developed protocol for the prevention of perioperative complications relating to infection and expansion in high-risk anatomic sites.
组织扩张器已成为小儿烧伤重建中一种有用的辅助手段。我们回顾了1984年6月至1995年7月期间使用组织扩张器的经验。301例患者共使用了403个扩张器。将1987年7月至1995年7月期间与特定解剖区域相关的并发症与该杂志1984年6月至1987年6月期间先前发表的数据进行了比较。如果并发症导致扩张器丢失或需要额外手术，或者术前计划无一得到满足，则定义为绝对并发症。相对并发症定义为点状脱发、脱发超过50%，或者手术计划仅部分得到满足，有时意味着手术判断不佳。1984年6月至1987年6月期间的总体并发症发生率为30%（122个扩张器出现37例并发症）。在1987年7月至1995年7月的研究中，并发症发生率仅为18%（281个扩张器出现51例并发症）。这两个时期之间的差异具有统计学意义（p = 0.010）。在最近的8年期间，与先前的研究相比，绝对和相对并发症均有所减少。这一时期最常见的绝对并发症是感染（31例中有15例，48%），其中12例（39%）为早期感染。关于颈部、面部、耳部和锁骨上区域的9例并发症，三分之二与扩张器渗漏或外露有关，这是由于解剖区域狭窄导致扩张器机械损伤以及覆盖皮肤缺血所致。在研究早期，下肢被证明是难以扩张或扩张效果不理想的区域，在研究的剩余时间里放弃了下肢扩张。绝对和相对并发症的总体减少可能是手术经验增加以及制定了预防与高风险解剖部位感染和扩张相关的围手术期并发症方案的结果。
