Multidisciplinary Application of an External Tissue Expander Device to Improve Patient Outcomes: A Critical Review

Dardano, Anthony N.; Klapper, Andrew; Parekh, Selene G.; Soliman, Mohsin Q; Valerio, Ian L.

doi:10.1089/wound.2019.1112

Cited by 13 publications

(23 citation statements)

References 38 publications

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“…In a separate report, Huh and Parekh 14 used a continuous external tissue expansion device after TAR-AA, a product that has also been used for large soft tissue wound management. 17,26 This device has external hooks placed on in the skin either side of the incision and connects them with a shoestring-like cable under tension. They reported decreased wound complication rates in 35 patients with this device, although no quantitative evidence was provided.…”

Section: Discussionmentioning

confidence: 99%

“…This study cohort is larger than previously published studies with similar methods (using other products) and duration of follow up. 17,18,23,28…”

Section: Discussionmentioning

confidence: 99%

“…This study cohort is larger than previously published studies with similar methods (using other products) and duration of follow up. 17,18,23,28 The primary limitations of the study are in its study design. Although a randomized prospective study would be more ideal because it can adjust for confounders such as surgeon experience, implant choice, and standardize suture closure technique, the current study comparing consecutively treated patients by the same surgeons does indicate a potentially clinically significant difference in outcomes with and without NSESs.…”

Section: Induction Of New Tissue Formation At the Peripherymentioning

confidence: 99%

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Noninvasive Soft Tissue Expansion Strips and Wound Complications After Total Ankle Arthroplasty

et al. 2022

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Background: Total ankle arthroplasty through the anterior approach (TAR-AA) is an increasingly popular treatment for ankle arthritis, but it carries a known risk for wound complications. Several products have been investigated to mitigate this risk; however, most are either costly or invasive. Noninvasive skin expansion strips (NSESs) were designed to transfer tension away from the incision and induce new skin growth at the edges of the strips. We hypothesize that postoperative application of NSESs will decrease unplanned clinic visits and wound complications after TAR-AA. Methods: This is a prospective cohort study of 41 patients at a single institution (3 surgeons) treated with NSESs after undergoing TAR-AA. An additional 41 consecutive historical patients treated without NSESs were retrospectively included as a control group. Patients received application of NSESs in the operating room after routine wound closure and again 2 weeks postoperatively. No other changes were made to the surgeons’ wound closure technique, immobilization, follow-up timing, or rehabilitation protocols. Primary outcomes included (1) additional clinic visit required for wound assessment or suture removal, (2) superficial wound complication, and (3) deep infection. Results: Baseline demographics did not differ significantly from our 41 consecutively treated historical controls. Additional clinic visits for suture removal or wound evaluation were significantly lower for patients treated with NSESs (15%, 6 of 41) compared to the control group (49%, 20 of 41) ( P = .001). There was also a significant difference in the superficial wound complication rate in the treatment group vs control group, 2% and 12%, respectively ( P = .04). There were no deep infections in either group. Conclusion: Noninvasive skin expansion strips placed after TAR-AA with an anterior approach have the potential to decrease wound complications and unplanned clinic visits. Further high-volume or randomized studies are needed to clarify their cost effectiveness and effect on long-term outcomes. Level of Evidence: Level II, prospective cohort study.

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Section: Discussionmentioning

confidence: 99%

“…This study cohort is larger than previously published studies with similar methods (using other products) and duration of follow up. 17,18,23,28…”

Section: Discussionmentioning

confidence: 99%

Section: Induction Of New Tissue Formation At the Peripherymentioning

confidence: 99%

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Noninvasive Soft Tissue Expansion Strips and Wound Complications After Total Ankle Arthroplasty

et al. 2022

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“…The device’s intrinsic mechanism prevents overtightening and maintains tension at 11.7 Newton (1.2 kg). 2 The device was tightened to the maximum allowed tension in all instances. If the wound was edematous, measures such as extremity elevation and ACE wrapping were applied.…”

Section: Methodsmentioning

confidence: 99%

Management of Large Pediatric Wound Defects Using a Continuous External Tissue Expander

Choi

Mehta

Luo

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Both internal and external tissue expanders take advantage of the innate adaptive mechanisms the skin exerts in response to mechanical tension, known as the stress-relaxation phenomenon. Internal tissue expander use is time-consuming and can be complicated by infection and extrusion. In this case series, continuous external tissue expanders used to manage large pediatric wounds were assessed. Fourteen patients (ages: 4 days to 17 years) with large wounds underwent continuous external tissue expansion intraoperatively. The success of wound closure was assessed. In addition, the size of the patient’s wounds, duration of device application, and postoperative complications were evaluated. The continuous external tissue expander was applied to wound sizes ranging from 14.7 to 560 cm 2 for 5 to 10 days until the wound was amenable for direct closure. In 11 of the 14 patients, delayed primary closure was achieved. The device significantly reduced the wound sizes of the remaining three cases (average 80% size reduction). There was no incidence of wound dehiscence or infection. This case series demonstrates the benefit of the continuous external tissue expansion in managing pediatric wounds that would not otherwise be amenable to primary closure. The method allows for timely closure with limited risk of infection or extrusion, and should be in the armamentarium of reconstructive plastic surgeons.

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“…Therefore, surgeons have long been searching for a practical, simple and effective method to achieve wound closure while maintaining aesthetics. The external tissue expansion technique may be a new choice for the reconstruction of skin soft tissue defects with the benefits of simplicity and minimal invasiveness [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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

Tong

Zhang

et al. 2022

Burns &Amp; Trauma

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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.

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Multidisciplinary Application of an External Tissue Expander Device to Improve Patient Outcomes: A Critical Review

Cited by 13 publications

References 38 publications

Noninvasive Soft Tissue Expansion Strips and Wound Complications After Total Ankle Arthroplasty

Noninvasive Soft Tissue Expansion Strips and Wound Complications After Total Ankle Arthroplasty

Management of Large Pediatric Wound Defects Using a Continuous External Tissue Expander

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

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