Tissue Expander Complications in the Pediatric Burn Patient

Patel, Parit A.; Elhadi, Haithem; Kitzmiller, W. John; Billmire, David A.; Yakuboff, Kevin P.

doi:10.1097/sap.0b013e3182a884af

Cited by 40 publications

(36 citation statements)

References 15 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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“…[22][23][24] Therefore, the multidirectional relaxing incision during scalp wound closure provides improved flap mobility, resulting in a decreased risk of wound margin tension and dehiscence. 23,[25][26][27] According to Bilkay et al, 28 there was no need for capsule excision, but only scoring with great attention, to release the tightness without affecting the blood supply. Raposio et al 29 demonstrated that each linear incision applies a significant mean gain of 1.67 mm in tissue mobility and a 40% reduction in the closing tension.…”

Section: Discussionmentioning

confidence: 99%

“…During the expansion process, the epidermis exhibits increasing mitotic activity, and the dermis thins significantly, which is frequently masked by the thick fibrous capsule formation all around the expander, resulting in limitation in flap mobility during the reconstruction process 22–24 . Therefore, the multidirectional relaxing incision during scalp wound closure provides improved flap mobility, resulting in a decreased risk of wound margin tension and dehiscence 23,25–27 …”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients

2023

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Background: Scalp expansion is an optimal treatment for alopecia resulting from burn injuries, especially in the pediatric population through providing highly vascularized adjacent local tissues with optimal hair density, color matching, texture, and hair-bearing characteristics. The aim of this study was to evaluate the efficacy of anterior capsulotomy and basal capsulectomy adherent to expanded scalp flap during alopecia reconstruction with scalp expansion in pediatric burned patients. Methods: The study was conducted on 127 patients with an age range of 5 to 19 years who presented with postburn alopecia accompanied by hairline loss. The patients were divided into 2 groups: group I consisted of 58 patients who were operated on using conventional technique, and group II consisted of 69 patients who were operated using modified technique including basal capsulectomy on the skull side and anterior capsulotomy on the expanded scalp flap. Results: The Hairdex, a validated questionnaire of Hair-Specific Health-Related Quality of Life measures, showed that percentage of satisfaction concerning outcomes was 91.50%, psychological well-being was 95%, and self-confidence was 84.30% in group II, compared with 63%, 55.70%, and 66.20%, respectively, in group I. This significant values had a great positive effect on patient satisfaction, changing child's behavior and self-confidence. Conclusion: Although physiological background of tissue expansion is the same, proper flap design with anterior capsulotomy on flap undersurface and basal capsulectomy on the skull side improve results of the traditional method significantly and minimize the complication rate. These surgical modifications provide maximum benefits from expanded tissue, with restoration of the hairline and a uniform hair direction.

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“…Biomechanical and viscoelastic properties of the skin 1 which allow it to stretch to close the wound within a relatively short period of time are mechanical creep and stress relaxation . 2 Our study was aimed to access the efficacy of preoperative SS technique as an alternative to conventional techniques for wound closure and to assess various outcome parameters related to the same. No similar study using the tension relief system (TRS) has been reported before in the past literature from India.…”

Section: Introductionmentioning

confidence: 99%

Role of Preoperative Skin Stretching in Single-Stage Wound Closure

Kumar

Jha

2022

Indian J Plast Surg

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Background Mechanical skin stretching (SS) is now becoming one of the commonly sought after procedures for wound healing. This study was aimed to assess the efficacy of preoperative SS for the closure of large wounds and to evaluate various postoperative outcome parameters. Methodology An observational study was conducted from December 2017 to May 2019 where a sample size of 30 patients was included with inclusion criteria being wounds of ≥5 cm width that require surgical management, presence of sufficient healthy skin edge of the wound/scar (at least one) for the stretching procedure, and age between 18 and 70 years. SS devices used were the top closure tension relief system. Postoperatively, various parameters were recorded to evaluate outcomes and complications. Results Majority of wounds that is 16 (53.3%) were <50 cm2, 9 (30%) were between 50 and 75 cm2, and 5 (16.7%) were >75 cm2. The mean duration of stretch was 2.3 ± 0.82 weeks. For 30 wounds treated with staged cycles of wound closure, there was a significant difference between every two visit points, i.e., 10%. The mean patient-reported patient and observer scar assessment scale score was 3.5 ± 0.93. Twenty-five cases (83.3%) had uneventful postoperative recovery. Twenty-seven patients (90%) reported an improved aesthetic outcome. Fourteen patients (46.7%) reported some improvement in function. Conclusion The study concluded that the SS devices are the simple and effective method for the primary closure of large and challenging wounds and skin defects.

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Tissue Expander Complications in the Pediatric Burn Patient

Abstract: After changing our tissue expander protocol, the complication rates at our institution have remained stable during the 10-year follow-up period. Tissue expansion in the pediatric burn population continues to be a safe and effective reconstructive option with acceptable complication rates.

Cited by 40 publications

References 15 publications

Macrophages are necessary for skin regeneration during tissue expansion

Macrophages are necessary for skin regeneration during tissue expansion

The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients

Role of Preoperative Skin Stretching in Single-Stage Wound Closure

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