A systematic review of complications associated with direct implants vs. tissue expanders following Wise pattern skin-sparing mastectomy

Safran, Tyler; Viezel-Mathieu, Alex; Shash, Hani; Neel, Omar Fouda

doi:10.1016/j.bjps.2017.02.028

Cited by 46 publications

(46 citation statements)

References 34 publications

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“…Complications of tissue expanders placed throughout the body are reported between 0 and 48% in the literature . A recent meta‐analysis of tissue expanders placed throughout the entire body reported an overall complication rate of 17.44%, higher than the overall head and neck complication rate of 8.73% (616/7058) reported in the current review .…”

Section: Discussionmentioning

confidence: 47%

“…Furthermore, tissue expansion is not always well tolerated due to temporary disfigurement, discomfort, and the numerous visits required for expansion . Complications arising from tissue expansion are reported between 0% and 48% in the literature . In the head and neck, tissue expanders are commonly used notably for burns, ear reconstruction, and congenital defects or nevi .…”

Section: Introductionmentioning

confidence: 99%

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Complications of tissue expansion in the head and neck

et al. 2019

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Background The authors aim to present a comprehensive review detailing the present state of evidence with regard to complications following tissue expansion in the head and neck. Methods A systematic literature search was conducted to identify all studies reporting complications of tissue expansion in the head and neck between 2000 and 2019. Subgroup comparisons based on expander locations and planes were conducted. Results A total of 7058 patients were included. Tissue expansion was associated with an overall complication rate of 8.73% (616/7058). The most common complications were extrusion (207/7009; 3.0%) and hematoma (200/7009; 2.9%). Overall complications were highest in the scalp (65/238; 27.3%) and lowest in the mastoid (347/5688; 6.1%). Complications were more common with expansion in the non‐subcutaneous plane (63/590; 10.7%). Conclusion In the absence of large clinical trials, systematic reviews such as these can help inform clinical guidelines and provide practitioners with an evidence‐based reference to improve informed consent.

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Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 99%

Complications of tissue expansion in the head and neck

et al. 2019

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“…Ulceration may occur increasing the possibility of infection. 14 Maximum stress is attributable to the collagen fibril density, elastin content, and sample tissue thickness and represents the maximum force that should be applied during tissue expansion. The higher maximum stress and MTM of scalp suggest that this tissue may be expanded more aggressively than other sites.…”

Section: Discussionmentioning

confidence: 99%

“…All tissue expansion carries risks of wound dehiscence and infection. 14 Although expansion with balloon-type devices can be controlled, multiple fills are required. Self-expanding osmotic hydrogel devices, on the other hand, are implanted once, the incision closed, and the hydrogel expands on its own.…”

Section: Introductionmentioning

confidence: 99%

Baseline Biomechanical Properties of Epithelia prior to Tissue Expansion in Dogs

Bowling

Davidson

Tholpady

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:Soft-tissue deficiencies pose a challenge in a variety of disease processes when the end result is exposure of underlying tissue. Although multiple surgical techniques exist, the transposition of tissue from one location to another can cause donor-site morbidity, long incisions prone to dehiscence, and poor patient outcomes as a result. Use of tissue expansion prior to grafting procedures has been shown to have success in increasing available soft tissue to aid in repairing wounds. However, the current tissue expanders have biomechanical limits to the extent and rate of expansion that usually exceeds the tissue capacity, leading to incisional dehiscence or expander extrusion. Understanding the baseline biomechanical properties of the tissue to be expanded would provide useful information regarding surgical protocol employed for a given anatomical location. Therefore, the aim of this study was to test and compare the baseline (preexpansion) biomechanical properties of different common expansion sites in dogs.Methods:Four samples measuring approximately 20 × 15 × 1 mm were harvested from 8 dogs. The samples were collected from the hard palate, alveolar mucosa, scalp, and chest of the animal and analyzed for stress, strain, maximum tangential stiffness, maximum tangential modulus, and tensile strength using a Texture Technologies TA.XT texture analyzer with corresponding biomechanical measurement software. Samples were compared as to their baseline biomechanical properties prior to any soft-tissue expansion. Histological sections of the samples were analyzed using hematoxylin eosin in an attempt to correlate the histological description to the biomechanical properties seen during testing. Summary statistics (mean, standard deviation, standard error, range) are reported for stress, strain, maximum tangential stiffness, maximum tangential modulus, and tensile strength and for the histological parameters by intraoral site. Analysis of variance was used to compare the biomechanical and histological parameters among the 4 locations while accounting for multiple measurements from each dog.Results:The scalp had significantly higher maximum stress (σmax) than chest, mucosa, and palate (P < 0.0001), with no differences among the other 3 locations (P > 0.63). Scalp site also had significantly higher maximum tangential modulus (ε) than chest, mucosa, and palate (P < 0.006), with no differences among the other 3 locations (P > 0.17). The locations did not have significantly different maximum tangential stiffness (k; P = 0.72). Histologically, 2 separate patterns of collagen disruption were evident.Conclusion:Although different results were obtained than theorized, this study showed that the scalp had the greatest resiliency to expand prior to tearing, and the highest tangential modulus, with all sites having statistically similar modulus of elasticity. Based on this study, the scalp could be expanded more aggressively compared with the other sites.

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“…However, the wound reaches only 70% of its original strength after 6 weeks of treatment, so the onset of tissue expansion 6 weeks after surgery does not exclude the risk of wound dehiscence. Techniques have also been proposed that try to make minor incisions and thus reduce the risk of wound dehiscence, but this has occurred at the cost of poor visibility and increasing difficulty in achieving haemostasis [43]. Although a number of surgical approaches have been suggested to reduce as much as possible this risk, surgical wound dehiscence remains a significant problem in using open techniques.…”

Section: Complications Of Tissue Expansionmentioning

confidence: 99%

New Technologies of Tissue Expansion - Review Article

Trebuňová¹,

Živčák²,

Hudák³

et al. 2019

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Currently, plastic surgeons are often challenged to reconstruct extensive and complex tissue defects in various areas of the body. Despite the availability of a variety of operative approaches in practice that are applicable in the long term for the reconstruction of tissue defects, donor and autologous transplants, skin grafts, implants, etc., the result is often not satisfactory. Restrictions of these techniques in restoring and repairing tissue serve as a driving force for the development of new techniques, the development of adipose tissue in tissue engineering. From a didactic point of view, the expansion could be divided into 3 rd groups. The first group consists of physiological expansion, e.g. growth of an individual. The second group includes pathological expansion, i. skin growth over areas of tumours. The third group includes artificial expansion, which was an important part of cosmetic or ethnic adaptations for some tribes. This review article is addresses the application of tissue expansion in various types of tissues, skin, muscles and bones, as well as its localization and its side effects.

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A systematic review of complications associated with direct implants vs. tissue expanders following Wise pattern skin-sparing mastectomy

Cited by 46 publications

References 34 publications

Complications of tissue expansion in the head and neck

Complications of tissue expansion in the head and neck

Baseline Biomechanical Properties of Epithelia prior to Tissue Expansion in Dogs

New Technologies of Tissue Expansion - Review Article

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