External Port Tissue Expansion in the Pediatric Population: Confirming Its Safety and Efficacy

Azadgoli, Beina; Fahradyan, Artur; Wolfswinkel, Erik M.; Tsuha, Michaela; Magee, William P.; Hammoudeh, Jeffrey A.; Urata, Mark M.; Howell, Lori K.

doi:10.1097/prs.0000000000004372

Cited by 23 publications

(34 citation statements)

References 18 publications

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“…Skin tissue expansion can harvest enough “extra skin tissue” which is similar in texture, color and flexibility to the lost tissue to reconstruct large skin defects after trauma, tumor excision or infection. However, multiple surgical procedures, low expansion efficiency, and high complication rates limit its application [4, 5]. Therefore, the mechanism by which skin responds to mechanical strain remains to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Macrophages are necessary for skin regeneration during tissue expansion

et al. 2019

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BackgroundTissue expansion is a procedure that promotes skin regeneration by mechanical stretch. During the stress and relaxation cycle, the skin undergoes a repeated microtrauma which triggers an immune response leading to the recruitment of macrophages to repair the damaged tissue. Macrophages have been found to be necessary for tissue repair and wound healing, but their effects on skin regeneration during mechanical stretch remain unclear.MethodsThe dynamic changes of macrophages in the rat skin tissues undergoing expansion were quantitatively determined by immunohistochemistry staining. The area of the expanded skin, skin thickness, dermal collagen density, cell proliferation and tissue vascularization were examined to determine the effects of macrophages on the expanding skin. The phenotypes of macrophages and the growth factors related to skin regeneration were also examined to evaluate the underlying mechanisms for the involvement of macrophages in skin regeneration. As a comparison, the tissue samples of expanding skin in which the macrophages were depleted by topically utilizing clodronate liposomes were also evaluated.ResultsThe number of skin macrophages in skin maintained in the high level during the skin expansion compared to non-expanded skin. We found that a switch from an M1- to M2-dominant response during tissue expansion. After the macrophages were depleted, the skin regeneration was inhibited, as evidenced by a smaller expansion area, thinner skin layers and decreased cell proliferation rate, collagen synthesis and, skin vascularization. The secretion of epidermal growth factor (EGF), fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF) were decreased when macrophages were depleted.ConclusionsOur findings suggest that macrophages are necessary for skin regeneration during tissue expansion. Modulating inflammation may provide a key therapeutic strategy to promote skin growth under mechanical strain.Electronic supplementary materialThe online version of this article (10.1186/s12967-019-1780-z) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Macrophages are necessary for skin regeneration during tissue expansion

et al. 2019

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“…According to our previous research between 2003 to 2012, the external placement of the injection port did not increase the probability of infection (internal vs external, 5.4% (38/703) vs 5.2% (139/2679)) [ 36 ]. Moreover, sterile saline injection via an external port is convenient and painless, especially for the pediatric population [ 37 ], and hospitalization is not required during the expansion period (between the insertion and removal of expanders). Given it is a non-invasive operation, saline injection by external port was performed by experienced nurses in the clinic as routine.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases

et al. 2021

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Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p < 0.001), larger volume of expander (200–400 ml vs <200 ml; OR, 1.74; p = 0.032; >400 ml vs <200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of <1 year, expander volume of >200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.

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“…In anatomically suitable areas of high tissue laxity, the use of multiple expanders divides the volume of expansion required in a single area and reduces the overall duration of expansion. Such benefit must be balanced against increased risk of infection with multiple expanders [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…The authors advocate minimal undermining of the port pocket with the fixation of sutures if the risk for port migration is high. Port externalization may have a higher infection rate, although has the benefit of painless filling, which is pertinent in the paediatric population [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Ten technical considerations revisited in tissue expansion

Geoghegan

Nikkhah

2020

Journal of Surgical Case Reports

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Tissue expansion is a versatile tool in resurfacing soft tissue defects of the breast, extremity, head and neck that involves the placement of a temporary implant adjacent to a soft tissue defect. Incremental expansion exploits the viscoelastic properties of skin to generate a skin flap that can be used to resurface defects and provide cover over permanent protheses. Infection, implant extrusion and skin necrosis are recognized complications of tissue expansion. This article presents a revised framework of 10 technical factors to reduce the risk of complications and optimize outcomes with tissue expansion using an illustrative case presentation.

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External Port Tissue Expansion in the Pediatric Population: Confirming Its Safety and Efficacy

Abstract: Therapeutic, IV.

Cited by 23 publications

References 18 publications

Macrophages are necessary for skin regeneration during tissue expansion

Macrophages are necessary for skin regeneration during tissue expansion

Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases

Ten technical considerations revisited in tissue expansion

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