Efficacy and safety of external tissue expansion technique in the treatment of soft tissue defects: a systematic review and meta-analysis of outcomes and complication rates

Abstract

Background Currently, various external tissue expansion devices are becoming widely used. Considering the scarcity of relevant application standards, this systematic review was performed to explore the effectiveness and safety of external tissue expansion techniques for the reconstruction of soft tissue defects. Method A systematic review and meta-analysis on the efficacy and safety of external tissue expansion technique was conducted. A comprehensive search was performed in the following electronic databases: PubMed/Medline, Embase, Cochrane Library (Wiley Online Library), and Web of Science. Studies reporting patients with soft tissue defects under the treatment of external tissue expansion technique were included. Results A total of 66 studies with 22 different types of external tissue expansion devices met the inclusion criteria. We performed a descriptive analysis of different kinds of devices. A single-arm meta-analysis was performed to evaluate the efficacy and safety of the external tissue expansion technique for different aetiologies. The pooled mean wound healing time among patients with defects after fasciotomy was 10.548 days [95% confidence interval (CI) = 5.796–15.299]. The pooled median wound healing times of patients with defects after excisional surgery, trauma, chronic ulcers and abdominal defects were 11.218 days (95% CI = 6.183-16.253), 11.561 days (95% CI = 7.062-16.060), 15.956 days (95% CI = 11.916-19.996) and 12.853 days (95% CI=9.444-16.227), respectively. The pooled wound healing rates of patients with defects after fasciotomy, excisional surgery, trauma, chronic ulcers and abdominal defects were 93.8% (95% CI=87.1-98.2%), 97.2% (95%CI=92.2-99.7%), 97.0% (95%CI=91.2-99.8%), 99.5% (95%CI=97.6-100%), and 96.8% (95%CI=79.2-100%), respectively. We performed a subgroup analysis in patients with diabetic ulcers and open abdominal wounds. The pooled median wound healing time of patients with diabetic ulcers was 11.730 days (95% CI = 10.334-13.125). The pooled median wound healing time of patients with open abdomen defects was 48.810 days (95% CI = 35.557–62.063) and the pooled successful healing rate was 68.8% (95% CI = 45.9-88.1%). A total of 1686 patients were included, 265 (15.7%) of whom experienced complications. The most common complication was dehiscence (n = 53, 3.14%). Conclusions Our systematic review is the first to demonstrate the efficacy and safety of external tissue expansion in the management of soft tissue defects. However, we must interpret the meta-analysis results with caution considering the limitations of this review. Large-scale randomized controlled trials and long-term follow-up studies are still needed to confirm the effectiveness and evaluate the quality of healing.

Platelet-rich gel versus external tissue expansion technique in treating scalp defects: A retrospective study

“…A total of 22 different kinds of external tissue expansion devices have been described in the literature, which can be classified into continuous and instant external tissue expanders according to the expansion method. [ 16 ] In this study, we chose 1 type of instant external tissue expander. Among the 12 patients treated with external TET in this study, 10 were sutured directly after skin stretching, and 2 healed with routine dressing changes after first-stage skin stretching to reduce the wound area.…”

Novel strategies in scalp expansion: improvements and applications of tissue expanders

“…Tissue expanders have been widely used in plastic and reconstructive surgery. They induce skin regeneration through mechanical tension and generate new tissue to repair and reconstruct soft tissue defects throughout the body [ 1 ]. The scalp, with its rich blood supply, vigorous cell proliferation and abundant hair follicle stem cells, can yield a significant amount of hair-bearing skin after expansion [ 2 ].…”

Vacuum Therapy in Complex Treatment of Purulent-Necrotic Diseases of Soft Tissues: Clinical Cases

“…После радикальных хирургических вмешательств по поводу флегмон, абсцессов, некротизирующей инфекции часто образуются обширные раневые дефекты, требующие индивидуального подхода в скорейшем их закрытии методами пластической хирургии. Оптимальным в закрытии таких ран является заживление по типу первичного натяжения [5][6][7][8], в противном случае прогрессирующий раневой процесс может приводить не только к неудовлетворительным косметическим результатам, но и завершаться инвалидизацией пациента [9][10][11][12]. Очень часто у истощенных инфекцией пациентов отмечаются негативные изменения иммунологического статуса, микробная и медикаментозная аллергизация, что также повышает риск негативного исхода лечения [13,14].…”