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Prognostic Analysis of Skin Scar Loosening and Tissue-Expansive Autologous Skin Grafting in the Treatment of Skin Postburn Scars. J Craniofac Surg 2022:00001665-990000000-00509. [DOI: 10.1097/scs.0000000000009149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022] Open
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Maamouri S, Zitouni K, Zairi I. [Complications of head and neck expansion: Acting on modifiable factors. A study of 98 prothesis]. ANN CHIR PLAST ESTH 2021; 66:385-394. [PMID: 34330554 DOI: 10.1016/j.anplas.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/02/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Tissue expansion is a key tool in the therapeutic arsenal that is proposed for repairing soft tissue losses of the head and neck. This technique, however interesting it may be, is not without its risks. The aim of this work is to identify the different steps of this procedure, determine the complications risk factors inherent to each step of the expansion and propose recommendations to improve functional and aesthetic results. PATIENTS AND METHODS We carried out a retrospective study on tissue expansion of the head and neck over a period of 10 years extending from January 2009 to December 2018, with at least one year follow-up for each patient. Our study counted 63 patients with the placement of 98 prostheses. We considered the various variables involved in the expansion process in order to determine those that increase the risk of complications. RESULTS In our series we counted 66.3 % of complications and 22.4 % of failures. We found that a young age increased the risk of skin suffering and that smoking increased the risk of hematoma occurrence. Neck expansion was found to be the riskiest site of expansion followed by the scalp that increased the risk of exposure (especially the parietal section of the scalp). The face is considered as an interesting site for expansion. We found that the use of multiple expanders is an attractive alternative to iterative expansions and to the choice of large expanders. CONCLUSION Tissue expansion of the head and neck requires careful planning that takes into account each step of the process.
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Affiliation(s)
- S Maamouri
- Faculté de médecine de Tunis, Hôpital Charles Nicole, tunis el manar, Tunis, Tunisie.
| | - K Zitouni
- Hôpital Charles Nicole, Tunis, Tunisie.
| | - I Zairi
- Hôpital Charles Nicole, Tunis, Tunisie.
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Yen P, Bucevska M, Reilly C, Verchere C. Can Tissue Expansion Reconstruction in the Trunk of Children Increase the Risk of Scoliosis? Plast Surg (Oakv) 2020; 29:88-97. [PMID: 34026671 DOI: 10.1177/2292550320933671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction We hypothesize that treatment of significant truncal lesions with truncal tissue expanders and subsequent flap surgery in pediatric patients may increase the risk of scoliosis. This study aims to investigate any relationship between tissue expansion (TE) and scoliosis and to compare the prevalence of scoliosis in our tissue expander population to the general population. Methods Health records of patients who underwent truncal TE at BC Children's Hospital between 1997 and 2017 were retrospectively reviewed and analyzed. The cross-sectional component of the study consisted of radiological imaging to establish the presence or absence of scoliosis. Results We identified 28 patients who underwent truncal TE over the study period. Ten had a scoliosis X-ray on their chart or as a part of the study. Three (10.7%) patients were identified as having developed scoliosis after TE. Conclusions We recommend that pediatric TE patients be made aware of the potential complication of scoliosis and be followed closely in the years during and after their treatment, in order to allow for preventative measures, early diagnosis and early management (if required).
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Affiliation(s)
- Paul Yen
- Division of Pediatric Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marija Bucevska
- Division of Pediatric Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Plastic Surgery, Department of Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Christopher Reilly
- Division of Pediatric Orthopedics, Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopedics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Cynthia Verchere
- Division of Pediatric Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Plastic Surgery, Department of Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
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Person H, Shipkov H, Guillot M, Mojallal A, Braye F, Brosset S. [Tissue expansion in child's burn reconstruction. Management principles and eleven years retrospective study of 42 patients]. ANN CHIR PLAST ESTH 2020; 65:131-140. [PMID: 32046862 DOI: 10.1016/j.anplas.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE With constraints and a risk of complication, tissue expansion in child's burn sequelae need a controlled surgical procedure, and a therapeutic plan appropriate to the specific pediatric healing, growth, and development. MATERIAL AND METHODS Our principles of management and technical points are described. A retrospective study of tissue expansion in child's burn sequelae between 2005 and 2016 is submitted. RESULTS There are 185 expanders, 98 protocols in 41 children, over half of sequelae concerning scalp, neck and chest. Mean age at the first expansion was 10.3 years old (5.8 years after burn). There are in average 2,4 (1-8) protocols by patient, with 1.9 (1-4) expanders by procedure. Surgical repair was a flap (78.8%), a full-thickness skin graft (13.3%) or both. Fifteen patients (30 expanders (14.6%) and 22 protocols (22.4%)), had expansion's complications, mostly infections and expositions. Eight patients (14 expanders (7.6%) and 10 protocols (10.2%)) had reconstructive's complications. An increase of burn area was a risk factor of complication (significant). Complicated expanders rate by location was 7.9% (scalp), 12.5% (neck), 9.8% (supraclavicular), 10.5% (chest), 19.4% (abdomen), 30% (buttock), 29.4% (lower limb), 1/2 (face). CONCLUSION Tissue expansion in child's burn sequelae is ideal in scalp, good in neck, chest and proximal upper limb, and to do carefully in lower limb and face.
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Affiliation(s)
- H Person
- Centre des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; Service de chirurgie plastique esthétique et reconstructrice, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - H Shipkov
- Centre des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; Service de chirurgie plastique esthétique et reconstructrice, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - M Guillot
- Centre des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - A Mojallal
- Centre des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; Service de chirurgie plastique esthétique et reconstructrice, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - F Braye
- Centre des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; Service de chirurgie plastique esthétique et reconstructrice, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - S Brosset
- Centre des brûlés de Lyon Pierre-Colson, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; Service de chirurgie plastique esthétique et reconstructrice, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
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Bjornson LA, Bucevska M, Verchere C. Tissue expansion in pediatric patients: a 10-year review. J Pediatr Surg 2019; 54:1471-1476. [PMID: 30301609 DOI: 10.1016/j.jpedsurg.2018.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/29/2018] [Accepted: 09/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Tissue expansion complication rates up to 40% have been reported in the pediatric population. This study aims to review one Canadian pediatric plastic surgeon's experience with tissue expansion by examining tissue expander and flap complication rates, and discussing important aspects of the tissue expansion experience. METHODS This is a retrospective chart review of the medical records of all tissue expansion patients treated by the senior author during a ten-year period. Data were collected on patient demographics, tissue expansion details, complications, and outcomes, and were analyzed descriptively. The relationship between tissue expander complications and flap complications was analyzed with odds ratio. RESULTS Ninety-three expanders were placed in 24 patients during 49 sessions. Complications occurred in 19 expanders (10 patients; 16 sessions), resulting in premature removal of nine. Only one session was unsuccessful; the expander became exposed and was removed after 1 month. The odds of having a flap complication were three times greater with preceding tissue expander complication (not statistically significant). CONCLUSIONS Our study identifies a 20% expander complication rate in the pediatric population. Patients with tissue expander complications subsequently experienced more flap complications than those without tissue expander complications. Complications do not preclude successful reconstruction. TYPE OF STUDY Prognostic. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Lindsay A Bjornson
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada; Division of Plastic Surgery, Department of Surgery, BC Children's Hospital, Vancouver, Canada
| | - Marija Bucevska
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada; Division of Plastic Surgery, Department of Surgery, BC Children's Hospital, Vancouver, Canada
| | - Cynthia Verchere
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada; Division of Plastic Surgery, Department of Surgery, BC Children's Hospital, Vancouver, Canada.
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Abstract
OBJECTIVE Tissue expansion is the preferred technique for the treatment of giant congenital melanocytic nevus (GCMN) located on the face, abdomen, and legs. We believe that the use of multiple tissue expanders in the same surgery is a safe and effective technique for the treatment of GCMN. MATERIALS AND METHODS A total of 14 patients were treated between 2013 and 2016 for GCMN removal with placement in the same surgery of 3 or more tissue expanders. We analyzed esthetic results and complications. RESULTS The locations of the GCMN on the 14 patients were on the abdomen, thigh, and shoulder. The number of tissue expanders placed was 3 in 5 patients, 4 in 6 patients, 5 in 1 patient, and 6 in 2 patients. The average stay was 4.29 days (1-9 days), and the average time until the removal of the expanders was 84.71 days (47-127 days). Only 2 patients had postoperative complications, with one having dehiscence of the surgical wound and the other an infection of the expander. CONCLUSIONS The use of multiple tissue expanders for GCMN is a safe technique that reduces the number of surgical interventions, achieving a total excision of the nevus in less time and at a younger age. The esthetic results are similar, and we have not observed a higher rate of complications.
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