Reconstruction with an Osmotic Tissue Expander in Pediatric Patients

Gronovich, Yoav; Tuchman, Izhak; Binenboym, Rami; Eizenman, Nirit; Golan, J

doi:10.1097/prs.0b013e31824a9f4e

Cited by 9 publications

(5 citation statements)

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“…1,[3][4][5] Despite advancements in reconstruction, TE is not without problems, including a lengthy expansion process, multiple operations, frequent clinical visits, and a cosmetic deformity during the expansion that may upset patients and their families. 11,12 In addition, frequent postoperative complications have been described following expansion. 5,6,[12][13][14] The overall complication rate of 5.7% reported in the NSQIP-P was much lower than rates between 12% and 40% described in smaller single-site retrospective reviews.…”

Section: Discussionmentioning

confidence: 99%

“…Despite advancements in reconstruction, TE is not without problems, including a lengthy expansion process, multiple operations, frequent clinical visits, and a cosmetic deformity during the expansion that may upset patients and their families 11,12. In addition, frequent postoperative complications have been described following expansion 5,6,12–14.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Tissue Expansion: Analysis of the National Surgical Quality Improvement Program–Pediatric

Harrison

Rizvi²,

Parsa³

et al. 2022

Journal of Craniofacial Surgery

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Introduction: Tissue expansion (TE) in pediatric surgery provides vascularized tissue to attain functional and esthetic goals in a broad range of reconstructive procedures. Our study evaluates the demographic, operative, and short-term outcomes of TE in pediatric patients utilizing the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database and highlights factors associated with postoperative complications. Materials and Methods: Retrospective review of a large multicenter database of 402 pediatric patients that underwent TE within the NSQIP-P database from 2013 to 2020 at freestanding general acute care children's hospitals, children's hospitals within a larger hospital, specialty children's hospitals, or general acute care hospitals with a pediatric wing. Patient demographics, clinical risk factors, operative information, and postoperative outcomes were collected with an odds ratio analysis of risk factors. Results: Patients were majority female (55.5%), White (63.2%), and non-Hispanic (67.4%). The minority were born prematurely (11.9%) and had congenital malformations (16.7%). Complications occurred in 5.7%, unplanned readmission in 4.5%, and unplanned operation in 6.5% of patients. Complications lead to readmission in 2.5% and return to the operating room in 3.2% of patients. American Society of Anesthesiology (ASA) score III-IV, congenital malformations, > 1-day hospital stay, and pulmonary, neurologic, and hematologic comorbidities were associated with the greatest increase in odds of complication. Conclusion:This study utilizes the NSQIP-P to provide a comprehensive multicenter view of pediatric patients undergoing TE. Increased understanding of risk factors for complications allows for guidance in patient selection and helps in achieving favorable surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pediatric Tissue Expansion: Analysis of the National Surgical Quality Improvement Program–Pediatric

Harrison

Rizvi²,

Parsa³

et al. 2022

Journal of Craniofacial Surgery

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“…Osmed® hydrogel has been previously reported to distract tissue safely for ophthalmic, dental and plastic surgery . Interestingly, Osmed® has also been tested in pediatric population for hypospadias repair, in which a self‐inflating cylindrical expander was used to allow excision of scar tissue and the potential to cover with expanded native skin …”

Section: Discussionmentioning

confidence: 99%

Expanding intestinal segment using osmotic hydrogel: An in vivo study

et al. 2018

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Intestinal circumferential expansion is essential for bowel lengthening in patients with Short Bowel Syndrome. We hypothesized use of an endoluminal osmotic hydrogel expander (EOHE) as a novel approach for intestinal expansion. An EOHE was introduced into an isolated intestinal segment of New Zealand rabbits, with a similar segment created as a control. After 4weeks, the segments were retrieved for analysis. Weight, inflammatory markers and fluoroscopy data was recorded weekly. EOHE allowed successful expansion of intestinal segments from 4.68 AE 0.35 to 9.79 AE 0.35 cm (p = 0.01). Increase in intestinal length was 167.8 AE 35.21% in segments with EOHE vs. 23.03 AE 4.2% in the control group (p < 0.01). A significant intestinal dilatation (214.4 AE 1.58 vs. 34.59 AE 1.23%, p < 0.01) was demonstrated. Hematoxylin and eosin stain revealed conservation of intestinal architecture with muscle hypertrophy and flattening of the epithelium possibly due to compression. No reduction of rabbit weight, inflammatory markers or liver damage was described. EOHE appears to produce safe intestinal expansion, achieving increased length and dilatation suitable for lengthening procedure. This approach may allow development of similar techniques to expand bowel in short bowel patients.

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“…The benefit of this kind of device is that it requires fewer visits and less pain, as the device is not accessed externally, which also reduces the risk of infection. 26 These devices have shown utility in scrotal expansion, given limited mobility and space in the area that make valve positioning difficult. 27 The surgeon is currently unable to control the rate and direction of this method of expansion, though a new direction-controlled self-inflating device has been developed and tested in animal models.…”

Section: Expander Selectionmentioning

confidence: 99%

Tissue Expansion in Children

Braun

Hamilton

Monson

et al. 2016

Seminars in Plastic Surgery

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Tissue expansion is a well-established surgical method that has been creatively applied to the management of many congenital and acquired pediatric conditions, including the removal of giant congenital melanocytic nevi and the separation of conjoined twins. Careful preoperative planning and patient follow-up are required to achieve the proper results and minimize complications. Special considerations for pediatric patients are present during each step of the process, from patient selection to postoperative care. The complication rate in tissue expansion remains high, though measures can be taken to reduce and effectively manage these complications.

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Reconstruction with an Osmotic Tissue Expander in Pediatric Patients

Cited by 9 publications

References 0 publications

Pediatric Tissue Expansion: Analysis of the National Surgical Quality Improvement Program–Pediatric

Pediatric Tissue Expansion: Analysis of the National Surgical Quality Improvement Program–Pediatric

Expanding intestinal segment using osmotic hydrogel: An in vivo study

Tissue Expansion in Children

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