TY - JOUR
T1 - Distant blunt forceps dissection in tissue expander insertion
T2 - A novel technique
AU - Weissman, Oren
AU - Hundeshagen, Gabriel
AU - Bank, Jonathan
AU - Zilinsky, Isaac
AU - Solomon, Efrat
AU - Remer, Eric
AU - Rasner, Guy
AU - Haik, Josef
N1 - Publisher Copyright:
© 2016 Canadian Society of Plastic Surgeons. All rights reserved.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Tissue expansion using implantable expanders is a useful means of generating surplus tissue for reconstruction of defects such as scarring following burns. The authors describe their technique of incisions distant to the desired location of expander placement, and remote dissection of the expander pocket with hydrodissection and blunt forceps. A total of 81 expanders were placed in 30 consecutive patients, 81% of whom had burn scars due for reconstruction. During preparation, no complications, such as bleeding, were encountered, except one case with severe subdermal fibrosis, in which bleeding was stopped through brief application of pressure. Postoperatively, no complications were encountered in 76% of patients; however, 16.6% exhibited surgical site infection, which was managed conservatively and was correlated with a high number of expanders implanted at once. One patient experienced hematoma formation that resolved spontaneously, and one instance of expander extrusion and subsequent removal occurred. Receiving ≥2 expanders at the same time was statistically associated with higher risk for complication(s). The authors' complication rates were moderate and comparable with open or endoscopic approaches. Time of expansion is reduced compared with the open approach due to distant incision placement and immediate usability. Cost effectiveness appeared to be better using only inexpensive forceps, rather than elaborate and costly endoscopic equipment.
AB - Tissue expansion using implantable expanders is a useful means of generating surplus tissue for reconstruction of defects such as scarring following burns. The authors describe their technique of incisions distant to the desired location of expander placement, and remote dissection of the expander pocket with hydrodissection and blunt forceps. A total of 81 expanders were placed in 30 consecutive patients, 81% of whom had burn scars due for reconstruction. During preparation, no complications, such as bleeding, were encountered, except one case with severe subdermal fibrosis, in which bleeding was stopped through brief application of pressure. Postoperatively, no complications were encountered in 76% of patients; however, 16.6% exhibited surgical site infection, which was managed conservatively and was correlated with a high number of expanders implanted at once. One patient experienced hematoma formation that resolved spontaneously, and one instance of expander extrusion and subsequent removal occurred. Receiving ≥2 expanders at the same time was statistically associated with higher risk for complication(s). The authors' complication rates were moderate and comparable with open or endoscopic approaches. Time of expansion is reduced compared with the open approach due to distant incision placement and immediate usability. Cost effectiveness appeared to be better using only inexpensive forceps, rather than elaborate and costly endoscopic equipment.
KW - Hypertrophic scarring
KW - Minimally invasive technique
KW - Postburn reconstruction;Tissue expansion
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U2 - 10.1177/229255031602400305
DO - 10.1177/229255031602400305
M3 - Article
AN - SCOPUS:84983027502
SN - 1195-2199
VL - 24
SP - 174
EP - 176
JO - Canadian Journal of Plastic Surgery
JF - Canadian Journal of Plastic Surgery
IS - 3
ER -