Tissue expander complications in plastic surgery: a 10-year experience

INTRODUCTION: Tissue expanders have been of great value in plastic surgery. Tissue expansion was developed for a specific indication; however, within a very short time, the concept of tissue expansion found wide applicability. From 1990 to 1999, 315 expanders in 164 patients were utilized. A retrospective analysis of complications and prognostic factors for complications were done. METHODS: The indications for tissue expansion were burns (50%), trauma (32%), and sequelae of previous surgery (8.8%). The expanders were inserted most frequently in the scalp, trunk and neck. RESULTS: There were 22.2% of complications and the most common were expander exposure (50%), infection (24%) and bad function of the expander (12.8%). The present study revealed an increased rate of minor complications in the group of 0 to 10 years of age and an increased rate of major complications for face and neck expansions compared to trunk expansion. There were no increased complication rates for the other age and anatomic site groups, previous expansion, concomitant expansion and type of expander used. CONCLUSIONS: The outcomes from tissue expansion procedures done in our hospital are similar to those reported in the literature. Tissue expansion is a good and safe technique.

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Tissue expansion as an alternative to skin grafting for closure of skin deficits

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-82-5-249 ◽

1992 ◽

Vol 82 (5) ◽

pp. 249-259 ◽

Cited By ~ 6

Author(s):

GR Johnson ◽

P Han ◽

JA Giacopelli

Keyword(s):

Case Report ◽

Lower Extremity ◽

Subcutaneous Tissue ◽

Tissue Expander ◽

Tissue Expansion ◽

Skin Grafting ◽

High Rate ◽

Expansion Process ◽

Technical Aspects ◽

Tissue Expanders

Recent advances in the technical aspects of tissue expanders for closure of skin deficits have led to an overall reduction in the high rate of complications typically associated with their usage. The authors provide a review of the recent refinements in the technique of the tissue expansion process. A discussion of current and future applications using this technique in the treatment of various lower extremity pathologies, including clubfoot, is presented. A case report on the use of a subcutaneous tissue expander for the treatment of a failed skin graft of the medial ankle is included.

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TISSUE EXPANSION

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.04.3008 ◽

2010 ◽

Vol 17 (04) ◽

pp. 611-615

Author(s):

MUHAMMAD AHMAD

Keyword(s):

Tissue Expander ◽

Major Complication ◽

Tissue Expansion ◽

Inclusion Criteria ◽

Flap Surgery ◽

Exclusion Criteria ◽

Acute Injuries ◽

Fill Volume ◽

Safe Technique ◽

The Mean

Objective: To share the experience of tissue expansion. Study Design: Descriptive. Duration: June 2005 to May 2009. Setting: Aesthetic Plastic Surgery, Rawalpindi. Inclusion Criteria: Patients of all ages and sex undergoing tissue expansion. Exclusion Criteria: Patients having acute injuries, burns and defects which were closed primarily. Patients undergoing primarily flap surgery. Materials and Methods: The shape and size of the tissue expander was chosen according to the deformity and expected wound geometry. All the surgerieswere performed under general anaesthesia. Drains were removed after 48 – 72 hours. Slightly filled (20 – 50ml) tissue expanders were used. Tissue expansion was started after 7 – 12 days and were filled twice weekly. Results: Total 19 patients (12 males & 7 females) were included in the study. The mean age in males was 32.9 years (range 13 – 44 years) and 21.1 years (range 19 – 36 years) in females. The differentdeformities included contractures 31.6%, Postburn scar 21.1%, hypertrophic scar 15.8% followed by congenital naevus 10.5%. The fill volume ranged from a 140 ml to 480 ml over a period of 8–13 weeks. No major complication was noted. Slight loss of distal flap occurred in 2 patients. No infection/rupture of tissue expander was seen. Conclusion: Tissue expansion is a safe technique for reconstruction of defects, with an obvious advantage of the availability of the adjacent skin.

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Iatrogenic Pneumothorax as a Complication to Delayed Breast Reconstruction With Tissue Expander—A Case Report

Plastic Surgery Case Studies ◽

10.1177/2513826x17747587 ◽

2017 ◽

Vol 3 ◽

pp. 2513826X1774758

Author(s):

Cecilie Balslev Willert ◽

Rikke Bredgaard

Keyword(s):

Breast Reconstruction ◽

Tissue Expander ◽

Tissue Expansion ◽

Reconstruction Method ◽

Complication Rates ◽

Unique Case ◽

Immediate Reconstruction ◽

Delayed Breast Reconstruction ◽

New Perspective ◽

Delayed Reconstruction

Breast reconstruction with expander implant is the most common breast reconstructive procedure. Irradiated patients are seldom reconstructed this way because the tissue expansion is difficult and the complication rates are higher. Pneumothorax is a serious condition and can be seen as a complication to the operation. Literature is sparse; hence, the only study is by Schneider et al who found an incidence of 0.55%. The study focused on immediate reconstruction only and did not report the percentage of irradiated patients. We present a unique case of iatrogenic pneumothorax in a previously irradiated patient undergoing delayed reconstruction with expander insertion. This provides a new perspective to the complication, raising the question whether irradiated patients are at higher risk. As a plastic surgeon, it is important to be aware of this complication and to take account of radiation when selecting reconstruction method.

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Der Erzieher als Manager

VIERTELJAHRSSCHRIFT FÜR WISSENSCHAFTLICHE PÄDAGOGIK ◽

10.30965/25890581-09501046 ◽

2019 ◽

Vol 95 (4) ◽

pp. 517-530

Author(s):

Diana Lohwasser

Keyword(s):

Educational Process ◽

The Other ◽

Critical View ◽

Other Hand ◽

The One ◽

Short Time ◽

Time Diagnosis

Abstract The Educator as a Manager. A Critical View In the following article tasks and motifs of the educator as manager are described. It is clear that there are other educator metaphors and associated behaviors. To some extent, the actions of the different educator metaphors overlap, but they differ in their purpose and perspective on the educational process and the person to be educated. First, a short time diagnosis is made, which describes the context of this metaphor of the educator as manager. Subsequently, on the one hand, the various motifs, tasks and objectives of an educator as manager are discussed. On the other hand, it is asked if it is possible in the current discourse to take a different perspective on the educational process.

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Simultaneous Mastopexy Explantation With a Vertical Bipedicle and Novel Open Pattern Marking Technique

Aesthetic Surgery Journal Open Forum ◽

10.1093/asjof/ojab001 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Elliot M Hirsch

Keyword(s):

Plastic Surgery ◽

Breast Implant ◽

Implant Removal ◽

Consecutive Series ◽

Level Of Evidence ◽

Areola Complex ◽

Depth Analysis ◽

Safe Technique ◽

Marking Technique ◽

Technical Considerations

Abstract There are limited studies in the plastic surgery literature that detail technical considerations in simultaneous breast implant removal and mastopexy procedures. These procedures are difficult, with significant potential for complications and poor cosmesis. The current plastic surgery literature describes a limited number of techniques that address these concerns, virtually all of which are variants of superior or superior medial pedicle vertical pattern mastopexy. This paper details a safe technique for simultaneous explantation and mastopexy with a novel open marking pattern and vertical bipedicle, which can restore breast cosmesis following implant removal. The study will briefly retrospectively review the results of a consecutive series of 86 patients who underwent this procedure from November 2018 to November 2019, with no incidence of partial or total nipple-areola complex necrosis. Thus, the technique is safe and allows the flexibility for intraoperative adjustments that are necessary for these procedures. A future study will conduct a more in-depth analysis of the results. Level of Evidence: 4

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Long-term outcomes of two-stage, immediate and delayed breast reconstruction with polyurethane-covered versus textured implants: protocol of a prospective, multicentre randomised controlled trial (TIPI trial)

BMJ Open ◽

10.1136/bmjopen-2020-044219 ◽

2021 ◽

Vol 11 (5) ◽

pp. e044219

Author(s):

J X Harmeling ◽

Kevin Peter Cinca ◽

Eleni-Rosalina Andrinopoulou ◽

Eveline M L Corten ◽

M A Mureau

Keyword(s):

Randomised Controlled Trial ◽

Breast Reconstruction ◽

Controlled Trial ◽

Capsular Contracture ◽

Tissue Expander ◽

Complication Rates ◽

Two Stage ◽

Randomised Controlled

IntroductionTwo-stage implant-based breast reconstruction is the most commonly performed postmastectomy reconstructive technique. During the first stage, a tissue expander creates a sufficiently large pocket for the definite breast implant placed in the second stage. Capsular contracture is a common long-term complication associated with implant-based breast reconstruction, causing functional complaints and often requiring reoperation. The exact aetiology is still unknown, but a relationship between the outer surface of the implant and the probability of developing capsular contracture has been suggested. The purpose of this study is to determine whether polyurethane-covered implants result in a different capsular contracture rate than textured implants.Methods and analysisThe Textured Implants versus Polyurethane-covered Implants (TIPI) trial is a multicentre randomised controlled trial with a 1:1 allocation rate and a follow-up of 10 years. A total of 321 breasts of female adults undergoing a two-stage breast reconstruction will be enrolled. The primary outcome is capsular contracture at 10-year follow-up which is graded with the modified Baker classification. It is analysed with survival analysis using a frailty model for clustered interval-censored data, with both an intention-to-treat and per-protocol approach. Secondary outcomes are other complication rates, surgical revision rate, patient satisfaction and quality of life and user-friendliness. Outcomes are measured 2 weeks, 6 months, 1, 2, 3, 5 and 10 years postoperatively. Interim analysis is performed when 1-year, 3-year and 5-year follow-up is completed.Ethics and disseminationThe trial has been reviewed and approved by the Medical Research Ethics Committee of the Erasmus MC, University Medical Centre Rotterdam (MEC-2018-126) and locally by each participating centre. Written informed consent will be obtained from each study participant. The results will be disseminated by publication in peer-reviewed journals.Trial registrationNTR7265.

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Repair Exposure of the Postauricular Tissue Expander Using the Modified Brent Method: A 7-Year Experience

Ear Nose & Throat Journal ◽

10.1177/01455613211007967 ◽

2021 ◽

pp. 014556132110079

Author(s):

Tongyu Cao ◽

Qingguo Zhang

Keyword(s):

Soft Tissue ◽

Skin Flap ◽

Tissue Expander ◽

Tissue Expansion ◽

Ear Reconstruction ◽

Lower Pole ◽

Tension Free ◽

Subsequent Exposure ◽

Free Closure ◽

Complicated Conditions

Objectives: Ear reconstruction is a challenging surgery for the complicated conditions in patients with microtia. The tissue expansion techniques were necessary and relatively safe for patients with insufficient soft tissue. However, complications such as necrosis of expanded flap and exposure of tissue expander limited the popularization of this method. This study described the use of modified Brent method to handle the exposure of the postauricular tissue expander. Methods: From January 2013 to December 2019, 27 ear reconstruction patients with trauma or necrosis on an expanded skin flap and subsequent exposure of tissue expander were treated with modified Brent method, which consisted of 3 stages: removal of the expander, tension-free closure of wound, and framework fabrication; elevation of reconstructed ear; lobule rotation; and minor modification. Results: Fifty-six percent of exposures occurred in the lower pole of the tissue expander. Exposure usually occurred 54.5 days after implantation. The majority of reconstructed ears had a satisfactory appearance and showed relatively stable outcomes. Only one case of cartilage exposure required revision surgery and was repaired by the temporoparietal fascia. Conclusion: With reasonable distribution of expanded flap, prolonged interval, and sutures under tension-free conditions, complications like the occurrence of trauma or necrosis-induced exposure of tissue expander can be repaired efficiently by a staging modified Brent method.

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890. Incidence and Microbiology of Surgical Site Infection (SSI) after Breast Surgery

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1078 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S479-S479

Author(s):

Farah Tanveer ◽

Dima Youssef ◽

Mamta Youssef ◽

Susanna Szpunar ◽

Michelle Flood

Keyword(s):

Surgical Site Infection ◽

Breast Surgery ◽

Tissue Expander ◽

Empiric Therapy ◽

Site Infection ◽

Gram Positive ◽

Historical Cohort ◽

Gram Negative ◽

Tissue Expanders ◽

Student’S T

Abstract Background Surgical site infection (SSI) after breast surgery is much more common than expected after a clean surgical procedure. Although breast SSIs are primarily Gram-positive; recent literature shows an increase in Gram-negative infections. We assessed the risk factors and microbiology of SSI following breast surgery at our institution. Methods We conducted a historical cohort study of all (³ 18 y) females who had surgery from 1/1/2014-3/31/2019 and subsequent SSI within 90 days of the procedure. Two controls, matched for surgery type, were selected per case. Data were collected on demographic and clinical characteristics, surgery type, microbiology and antibiotics. Data were analyzed using the χ 2 test, Student’s t-test and multivariable logistic regression with a forward likelihood ratio algorithm. Results After excluding patients with limited data, we reviewed 284 charts: 95 of 132 cases and 189 controls. The 90-day incidence of SSI was 3.5 % (132/3755). Cases were younger than controls: 53.9 ± 12.4 years vs. 58.3± 13.7 years, respectively, p=0.02. Controls had more comorbidities: 1.8 ± 1.3 vs. 1.4 ± 0.7,respectively, p=0.001. Tissue expanders were placed in 65 (70%) cases versus 11 (5.8%) controls (p < 0.0001). After controlling for age, BMI, comorbidities and post-operative antibiotics, only tissue expanders were associated with infection (OR=35.1, p< 0.0001, 95% CI: 16.6, 74.0). Microbiological data were available for 84 cases. Gram-positive organisms accounted for 45 (53.6%) infections and Gram-negative organisms accounted for 39 (46.4%) infections. Over 72% of African Americans (p= 0.014), 76.5% of patients with diabetes (p=0.005) and 57.1 % with tissue expanders (p= 0.02) had Gram-negative infections. The table shows the multivariable predictors of Gram-negative infection. Tissue expander removal was required in 61.5% of patients with Gram-negative infections compared to 39% with Gram-positive infections. Predictors of Gram-negative SSI after breast surgery Conclusion Patients with tissue expanders had a higher incidence of SSI after breast surgery; removal was often required in Gram-negative infections. Diabetes and post-operative antibiotics were significant predictors of Gram-negative infection. Knowledge of local epidemiology is a key factor in deciding empiric therapy for SSI. Disclosures All Authors: No reported disclosures

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Amide-Type Substrates in the Synthesis of N-Protected 1-Aminomethylphosphonium Salts

Catalysts ◽

10.3390/catal11050552 ◽

2021 ◽

Vol 11 (5) ◽

pp. 552

Author(s):

Dominika Kozicka ◽

Paulina Zieleźny ◽

Karol Erfurt ◽

Jakub Adamek

Keyword(s):

Reaction Times ◽

The Other ◽

Hydroxyl Group ◽

Other Hand ◽

Step Procedure ◽

Higher Temperature ◽

Short Time ◽

Work Up

Herein we describe the development and optimization of a two-step procedure for the synthesis of N-protected 1-aminomethylphosphonium salts from imides, amides, carbamates, or lactams. Our “step-by-step” methodology involves the transformation of amide-type substrates to the corresponding hydroxymethyl derivatives, followed by the substitution of the hydroxyl group with a phosphonium moiety. The first step of the described synthesis was conducted based on well-known protocols for hydroxymethylation with formaldehyde or paraformaldehyde. In turn, the second (substitution) stage required optimization studies. In general, reactions of amide, carbamate, and lactam derivatives occurred at a temperature of 70 °C in a relatively short time (1 h). On the other hand, N-hydroxymethylimides reacted with triarylphosphonium salts at a much higher temperature (135 °C) and over longer reaction times (as much as 30 h). However, the proposed strategy is very efficient, especially when NaBr is used as a catalyst. Moreover, a simple work-up procedure involving only crystallization afforded good to excellent yields (up to 99%).

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COVID-19: systematic learning across boundaries requires a conceptual agreement

Scandinavian Journal of Public Health ◽

10.1177/14034948211027086 ◽

2021 ◽

pp. 140349482110270

Author(s):

Knut Ole Sundnes ◽

Geir Sverre Braut

Keyword(s):

Public Health ◽

Knowledge Base ◽

External Validity ◽

Evaluation Research ◽

The Other ◽

Basic Knowledge ◽

Early Publication ◽

Number Of Publications ◽

Short Time

The COVID-19 epidemic has revealed a shortage of basic knowledge and understanding of pandemics, especially regarding their dynamics and how to contain them. The results are a host of governments’ decrees and instructions, one replacing the other, often within the same week. It has further, in a truly short time, resulted in an overwhelming number of publications, many of them prioritising early publication over quality. This commentary addresses the concept of structured research related to disasters and how the use of endorsed guidelines will facilitate well-designed evaluation research with improved rigour and external validity, even if applied retrospectively. The outcome should be a solidified knowledge base. Further, the important role of public health efforts is to be highlighted, as their role has proved crucial during the COVID-19 pandemic.

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