A Comparative Analysis of Tissue Expander Reconstruction of Burned and Unburned Chest and Breasts Using Endoscopic and Open Techniques

Lévi, Benjamin; Brown, David L.; Cederna, Paul S.

doi:10.1097/prs.0b013e3181c91d27

Cited by 21 publications

(9 citation statements)

References 41 publications

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“…32 Remote incision, far from the stress of the expansion, also minimizes the chances of wound dehiscence. 12 Whether the risks of extrusion and de ation can be reduced by the endoscopic technique remain controversial. [11][12][13] Although the use of an endoscope reduces the length of surgical incision, the pockets for expander placement are not narrowed.…”

Section: Discussionmentioning

confidence: 99%

“…12 Whether the risks of extrusion and de ation can be reduced by the endoscopic technique remain controversial. [11][12][13] Although the use of an endoscope reduces the length of surgical incision, the pockets for expander placement are not narrowed. According to our experience in expander placement by both the endoscopic method and the open method, appropriate and uniform dissection of the plane depends on the degree of exposure.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopy-assisted versus open tissue expander placement in plastic and reconstructive surgery: a meta-analysis

Chen

Dong

Zhang

et al. 2022

Journal of Plastic Surgery and Hand Surgery

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BackgroundTissue expansion can solve the problem of tissue de ciency in plastic and reconstructive surgery, but it is a lengthy process with many possible complications. This meta-analysis aimed to determine whether endoscopy-assisted expander placement could decrease complications and shorten treatment time. MethodsA literature search was performed in eight databases from their inception dates up to November 22, 2020, to identify clinical studies on endoscopy-assisted and/or open tissue expander placement in plastic and reconstructive surgery. Risk difference (RD) and weighted mean difference (WMD), along with the 95% con dence intervals (95% CI), were calculated to compare the pooled results. ResultsSeven studies met the inclusion criteria. Of the 759 patients, 194 received endoscopy-assisted expander placement and 565 patients received open expander placement. Overall complication rate was signi cantly lower in the endoscopy-assisted group than in the open expander group (pooled RD − 0.28, 95% CI, − 0.38 to − 0.18, p < 0.001). Subgroup analysis showed signi cantly lower incidence rates for haemotoma, infection, and dehiscence, but not for extrusion and de ation. The endoscopy-assisted group also had signi cantly shorter surgery time (WMD, − 13.97 min; 95% CI, − 15.85 to − 12.08 minutes, p < 0.001), hospital stay (WMD, − 16.88 hours; 95% CI, − 24.36 to − 9.40 hours, p < 0.001), and time to full expansion (WMD, − 27.54 days; 95% CI, − 38.85 to − 16.24 days, p < 0.001). ConclusionsEndoscopy-assisted expander placement may help lower the risk of complications such as haemotoma, infection, and dehiscence, and also reduce surgery time, hospital stay, and time to full expansion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endoscopy-assisted versus open tissue expander placement in plastic and reconstructive surgery: a meta-analysis

Chen

Dong

Zhang

et al. 2022

Journal of Plastic Surgery and Hand Surgery

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show abstract

Section: Discussionmentioning

confidence: 99%

“…Some early studies reported that endoscopy-assisted expander placement requires a longer operative time, 27,28 but this was disproved by later research that showed that the endoscopic technique could signi cantly shorten placement time, especially when more than one expander had to be placed. [11][12][13]15 We believe that the contradictory conclusions were due to differences in the pro ciency of the surgeons in endoscopic operation. The small and remote incision, and the earlier initiation of expansion, all contribute to shorten hospital stay and time to full expansion.…”

Section: Discussionmentioning

confidence: 99%

Endoscopy-Assisted Versus Open Tissue Expander Placement in Plastic and Reconstructive Surgery: A Meta-Analysis

Dong

Zhou

et al. 2021

Preprint

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Background Tissue expansion can solve the problem of tissue deficiency in plastic and reconstructive surgery, but it is a lengthy process with many possible complications. This meta-analysis aimed to determine whether endoscopy-assisted expander placement could decrease complications and shorten treatment time. Methods A literature search was performed in eight databases from their inception dates up to November 22, 2020, to identify clinical studies on endoscopy-assisted and/or open tissue expander placement in plastic and reconstructive surgery. Risk difference (RD) and weighted mean difference (WMD), along with the 95% confidence intervals (95% CI), were calculated to compare the pooled results. Results Seven studies met the inclusion criteria. Of the 759 patients, 194 received endoscopy-assisted expander placement and 565 patients received open expander placement. Overall complication rate was significantly lower in the endoscopy-assisted group than in the open expander group (pooled RD − 0.28, 95% CI, − 0.38 to − 0.18, p < 0.001). Subgroup analysis showed significantly lower incidence rates for haemotoma, infection, and dehiscence, but not for extrusion and deflation. The endoscopy-assisted group also had significantly shorter surgery time (WMD, − 13.97 min; 95% CI, − 15.85 to − 12.08 minutes, p < 0.001), hospital stay (WMD, − 16.88 hours; 95% CI, − 24.36 to − 9.40 hours, p < 0.001), and time to full expansion (WMD, − 27.54 days; 95% CI, − 38.85 to − 16.24 days, p < 0.001). Conclusions Endoscopy-assisted expander placement may help lower the risk of complications such as haemotoma, infection, and dehiscence, and also reduce surgery time, hospital stay, and time to full expansion. (PROSPERO: CRD42021226116)

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“…An effective method of reconstruction can be accomplished with expansion of adjacent healthy tissue and serial transfer to replace the hypertrophic scar. For this purpose, tissue expanders can be placed through the scar or using minimally invasive endoscopic techniques which have been demonstrated to minimize associated complications [63]. …”

Section: Managementmentioning

confidence: 99%

Heterotopic Ossification and Hypertrophic Scars

Agarwal

Sorkin

Lévi

2017

Clinics in Plastic Surgery

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Burns and trauma lead to extensive superficial and deep soft tissue wounds which are unable to heal perfectly to the pre-injury state. Typically wound healing requires proliferation of cells capable of differentiating into the injured tissue type. As part of the structural requirements for tissue, these cells lay down extracellular matrix (ECM) often in the form of collagens. However, dysregulated cellular proliferation and collagen deposition often leads to wound pathology. Two conditions – heterotopic ossification (HO) and hypertrophic scarring – present a substantial challenge in the management of patients with large surface-area burns. HO is the pathologic formation of ectopic osseous lesions causing severe pain, non-healing wounds, and restricted range of motion. Current treatment strategies aimed at HO include prophylactic radiation therapy, non-steroidal anti-inflammatory drugs (NSAIDs), and bisphosphonates; ultimately patients who have developed HO may require surgical excision followed by prophylactic measures to reduce recurrence risk. Hypertrophic scars in contrast are non-osseous lesions caused by excessive collagen deposition. Similar to HO, hypertrophic scars are often painful, functionally limiting, and aesthetically displeasing. Treatment strategies include CO2 laser application, steroid injections, and excision with skin grafting. Here we review the biology, diagnosis, and treatment and outcomes associated with both forms of pathologic wound healing.

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A Comparative Analysis of Tissue Expander Reconstruction of Burned and Unburned Chest and Breasts Using Endoscopic and Open Techniques

Cited by 21 publications

References 41 publications

Endoscopy-assisted versus open tissue expander placement in plastic and reconstructive surgery: a meta-analysis

Endoscopy-assisted versus open tissue expander placement in plastic and reconstructive surgery: a meta-analysis

Endoscopy-Assisted Versus Open Tissue Expander Placement in Plastic and Reconstructive Surgery: A Meta-Analysis

Heterotopic Ossification and Hypertrophic Scars

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