Application of a pre-filled tissue expander for preventing soft tissue incarceration during tibial distraction osteogenesis

BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.METHODS Between January 2016 and December 2018,12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position.A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis.The tissue expander was removed when the two ends of the tibial defect were close enough.RESULTS In all 12 patients,the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis.When bone transport was adequate,the expander was removed and the bone transport process was completed.During the whole process,there was no incarceration of skin and soft tissue in the bone defect area.Complications occurred in one patient,who experienced poor wound healing.CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration.The authors’primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.

Meteorological Influence on Tissue Expander-Related Major Infection

Background Infection is a relevant complication of tissue expander surgery that may compromise the flap.The effects of meteorological variables on surgical site infection have been observed in many surgeries;however,their influence on tissue expander infection is unknown.Methods We identified tissue expander implantation and infection based on their International Classification of Diseases,10th revision,codes in electronic hospitalization summary reports of 26 cities from January 1,2014 to December 31,2015.The data of the present study were collected for administrative purposes without any personal identifiers.The Cox proportional hazard model was used to investigate the association between meteorological variables and tissue expander-related major infection with six covariates.Results A total of 3,089 patients were enrolled.Of them,8.7%experienced a major infection during the study period.The optimal daily average temperature was between 22.9℃and 26.8℃,and the risk of major infection was significantly decreased in this range.The minimal infection temperature was 24.4℃,with a hazard ratio of 0.85.When the average relative humidity was 37%,the infection risk was minimal with a hazard ratio of 0.86;however,a relative humidity of≥79%significantly increased the risk of infection.Conclusions This is the first study to investigate the impact of temperature and relative humidity on tissue expander-related major infection.Our study suggests that there may be an optimal range of both temperature(22.9℃–26.8℃)and relative humidity(<79%)that can lower the risk of major infection after tissue expander implantation.

Risk factors for tissue expander infection in scar reconstruction:a retrospective cohort study of 2374 consecutive cases

Background:Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes;however,the complications that emerge from tissue expansion hinder repair.Infection is considered a major complication of tissue expansion.This study aimed to analyze the perioperative risk factors for expander infection.Methods:A large,retrospective,single-institution observational study was carried out over a 10-year period.The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction.Demographics,etiological data,expander-related characteristics and postoperative infection were assessed.Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection.In addition,we conducted a sensitivity analysis for treatment failure caused by infection as an outcome.Results:A total of 2374 expanders and 148 cases of expander infection were assessed.Treatment failure caused by infection occurred in 14 expanders.Multivariate logistic regression analysis identified that disease duration of≤1 year(odds ratio(OR),2.07;p<0.001),larger volume of expander(200–400ml vs<200 ml;OR,1.74;p=0.032;>400ml vs<200 ml;OR,1.76;p=0.049),limb location(OR,2.22;p=0.023)and hematoma evacuation(OR,2.17;p=0.049)were associated with a high likelihood of expander infection.Disease duration of≤1 year(OR,3.88;p=0.015)and hematoma evacuation(OR,10.35;p=0.001)were so related to high risk of treatment failure.Conclusions:The rate of expander infection in patients undergoing scar reconstruction was 6.2%.Disease duration of<1 year,expander volume of>200 ml,limb location and postoperative hematoma evacuation were independent risk factors for expander infection.

Simultaneous expander and deep inferior epigastric perforator reconstruction:indications and alloderm sling technique for protecting the anastomosis

Aim:Autologous tissue is considered the“gold standard”for breast reconstruction today.However,little is known about deep inferior epigastric perforator(DIEP)flap reconstruction in combination with tissue expander(TE)/implant.The authors describe a series of combined DIEP flap/TE reconstruction,including its indications and technique to ensure protection of the pedicle during the expansion process.Methods:Between January 2009 and December 2012,patients undergoing immediate DIEP with TE reconstruction were retrospectively reviewed.Oncologic,comorbid conditions,intraoperative,postoperative expansion,complications,and technique data points were collected.Photographs were taken postoperatively and patient’s satisfaction surveys were obtained to assess overall satisfaction.Results:Five patients underwent immediate DIEP flap/TE reconstruction utilizing our alloderm sling technique.There were no complications to the pedicle,flap,expander,or mastectomy skin perioperatively or postoperatively.All patients describe being very satisfied,often with improved breast volume and projection as compared to their preoperative appearance.Conclusion:The results of this study suggest that DIEP flap/TE reconstruction is safe,in particular when utilizing the alloderm sling technique,and should be considered in patients who lack sufficient abdominal tissue,have existing breast asymmetries,or do not desire the scar deformity of latissimus dorsi.

Cost-effectiveness of one-stage versus two-stage breast reconstruction in the United Kingdom

Aim:Permanent expanders allow for breast reconstruction as a single stage.These prostheses are more expensive than conventional tissue expanders,but this excess cost is markedly offset as only one operation is required.However,if the revision rate is sufficiently high,then this effect is negated.We aim to compare costs of one-stage vs.two-stage reconstruction at a single center,taking into account explantation and unexpected admissions following complications.Methods:A retrospective review was carried out on all patients who underwent one-stage and two-stage reconstruction over a 5-year period by a single surgeon.A cost analysis was performed taking into account,explantation and additional admissions.Results:One hundred and forty-three one-stage and 45 two-stage procedures were included.The explantation rate for one-stage procedures is 36%,at a mean of 12.9 months postimplantation,the majority of which were exchanged for silicone implants to improve cosmesis.Four(9%)of the two-stage procedures were explanted a mean of 18 months postreconstruction.Overall,one-stage reconstructions were significantly more expensive than the two-stage group(P=0.016).Conclusion:There are many benefits of one-stage breast reconstruction.However,it does not appear to be cost-effective when additional admissions for explantation surgery are taken into account.