Complications in tissue expansion: A logistic regression analysis for risk factors. Issue 6 (September 2017)

• Record Type: Journal Article
• Authors: Smolle, Christian; Tuca, Alexandru; Wurzer, Paul; Spendel, Stephanie M.; Forbes, Abigail A.; Spendel, Stephan; Schintler, Michael; Haxhija, Emir; Schwenzer-Zimmerer, Katja; Friedl, Herwig; Kamolz, Lars-Peter; Parvizi, Daryousch
• Is Part Of: Burns. Volume 43:Issue 6(2017)
• Page Start: 1195
• Page End: 1202
• Publication Date: 2017-09
• Subjects: Tissue expander -- Risk factor -- Complication -- Body mass index; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2016.08.030
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: The Clavien–Dindo scale was used to determine severity of complications. Women are more prone to developing complications than men. A high body mass index is associated with better outcome. The majority of complications do not result in therapy failure. Treatment of burn scars does not result in more severe complications. Abstract: Background: Tissue expansion is frequently used in reconstructive surgery. Although the surgical procedure is typically considered simple, reported complication rates of tissue expansions exceed 40%. There is little evidence concerning risk factors for complications in tissue expansion in body regions other than breast. The aim was to determine risk factors for complications in non-breast tissue expansion. Methods: 34 patients treated with subcutaneous tissue expanders between 2005 and 2014 were analyzed. Demographic data, body-mass index (BMI), mean arterial blood pressure (MAP), treatment indications, expansion site, previous expansion therapies in the same body region, smoking history, as well as expander characteristics (shape, volume, and filling mechanism) were ascertained. Complications were assessed and ranked according to severity based on the Clavien–Dindo classification. Binary logistic regression analysis adjusted for clinical characteristics was used. A p < 0.05 was considered as statistically significant. Results: Complications were observed in 26 out of 71 expanders analyzed (36.6%), of whom 10 led to therapy failure. Expanders used in the limbs, female gender, and high expander volume turned out as significant risk factors. Patients with both a high MAP and low BMI developed tissue necrosis significantly more often (p = 0.002). The use of tissue expansion after a burn was not associated with an increased risk for complications. Conclusions: This is the first study revealing female gender and low BMI as risk factors in tissue expander surgery. Thus, careful patient selection is mandatory to avoid complications in tissue expansion. Burn patients do not develop complications more often.