Christian Smolle1, Alexandru Tuca2, Paul Wurzer3, Stephanie M Spendel4, Abigail A Forbes5, Stephan Spendel6, Michael Schintler6, Emir Haxhija7, Katja Schwenzer-Zimmerer8, Herwig Friedl4, Lars-Peter Kamolz2, Daryousch Parvizi6. 1. Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria; Research Unit Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria. Electronic address: christian.smolle@gmail.com. 2. Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria; Research Unit Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria. 3. Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria; Research Unit Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria; Department of Surgery, University of Texas Medical Branch, 815 Market St., Galveston, TX 77550-2725, USA. 4. Institute of Statistics, University of Technology Graz, Kopernikusgasse 24/III, A-8010 Graz, Austria. 5. Department of Surgery, University of Texas Medical Branch, 815 Market St., Galveston, TX 77550-2725, USA. 6. Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria. 7. Division of General Pediatric Surgery, Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria. 8. Division of Maxillofacial Surgery, Department of Dentistry and Oral Health, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria.
Abstract
BACKGROUND: Tissue expansion is frequently used in reconstructive surgery. Although the surgical procedure is typically considered simple, reported complication rates of tissue expansions exceed 40%. There is little evidence concerning risk factors for complications in tissue expansion in body regions other than breast. The aim was to determine risk factors for complications in non-breast tissue expansion. METHODS: 34 patients treated with subcutaneous tissue expanders between 2005 and 2014 were analyzed. Demographic data, body-mass index (BMI), mean arterial blood pressure (MAP), treatment indications, expansion site, previous expansion therapies in the same body region, smoking history, as well as expander characteristics (shape, volume, and filling mechanism) were ascertained. Complications were assessed and ranked according to severity based on the Clavien-Dindo classification. Binary logistic regression analysis adjusted for clinical characteristics was used. A p<0.05 was considered as statistically significant. RESULTS: Complications were observed in 26 out of 71 expanders analyzed (36.6%), of whom 10 led to therapy failure. Expanders used in the limbs, female gender, and high expander volume turned out as significant risk factors. Patients with both a high MAP and low BMI developed tissue necrosis significantly more often (p=0.002). The use of tissue expansion after a burn was not associated with an increased risk for complications. CONCLUSIONS: This is the first study revealing female gender and low BMI as risk factors in tissue expander surgery. Thus, careful patient selection is mandatory to avoid complications in tissue expansion. Burn patients do not develop complications more often.
BACKGROUND: Tissue expansion is frequently used in reconstructive surgery. Although the surgical procedure is typically considered simple, reported complication rates of tissue expansions exceed 40%. There is little evidence concerning risk factors for complications in tissue expansion in body regions other than breast. The aim was to determine risk factors for complications in non-breast tissue expansion. METHODS: 34 patients treated with subcutaneous tissue expanders between 2005 and 2014 were analyzed. Demographic data, body-mass index (BMI), mean arterial blood pressure (MAP), treatment indications, expansion site, previous expansion therapies in the same body region, smoking history, as well as expander characteristics (shape, volume, and filling mechanism) were ascertained. Complications were assessed and ranked according to severity based on the Clavien-Dindo classification. Binary logistic regression analysis adjusted for clinical characteristics was used. A p<0.05 was considered as statistically significant. RESULTS: Complications were observed in 26 out of 71 expanders analyzed (36.6%), of whom 10 led to therapy failure. Expanders used in the limbs, female gender, and high expander volume turned out as significant risk factors. Patients with both a high MAP and low BMI developed tissue necrosis significantly more often (p=0.002). The use of tissue expansion after a burn was not associated with an increased risk for complications. CONCLUSIONS: This is the first study revealing female gender and low BMI as risk factors in tissue expander surgery. Thus, careful patient selection is mandatory to avoid complications in tissue expansion. Burn patients do not develop complications more often.
Authors: Berry Fairchild; Warren Ellsworth; Jesse C Selber; David P Bogue; Dmitry Zavlin; Stephanie Nemir; Cristina M Checka; Mark W Clemens Journal: Aesthet Surg J Date: 2020-01-01 Impact factor: 4.283