Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases

Chen Dong; Minhui Zhu; Luguang Huang; Wei Liu; Hengxin Liu; Kun Jiang; Zhou Yu; Xianjie Ma

doi:10.1093/burnst/tkaa037

您当前的位置：

首页 >

文章列表页 >

Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases

更新时间：2022-06-14

- Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases
- Burns & Trauma Vol. 9, Issue 1, (2021)
- 作者机构：
  
  1. Department of Plastic Surgery
  2. Fourth Military Medical University
  3. Department of Burn and Plastic Surgery
  4. Information Center
- 作者简介：
- 基金信息：
- DOI：10.1093/burnst/tkaa037
  CLC：
- Published：2021，
  
  Published Online：4 January 2021，
扫描看全文
Chen Dong, Minhui Zhu, Luguang Huang, Wei Liu, Hengxin Liu, Kun Jiang, Zhou Yu, Xianjie Ma, Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases, Burns & Trauma, Volume 9, 2021, tkaa037, https://doi.org/10.1093/burnst/tkaa037
DOI：

Chen Dong, Minhui Zhu, Luguang Huang, Wei Liu, Hengxin Liu, Kun Jiang, Zhou Yu, Xianjie Ma, Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases, Burns & Trauma, Volume 9, 2021, tkaa037, https://doi.org/10.1093/burnst/tkaa037 DOI：

摘要

Abstract

BackgroundTissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however

the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection.MethodsA large

retrospective

single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics

etiological data

expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition

we conducted a sensitivity analysis for treatment failure caused by infection as an outcome.ResultsA total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR)

2.07; p < 0.001)

larger volume of expander (200–400 ml vs <200 ml; OR

1.74; p = 0.032; >400 ml vs <200 ml; OR

1.76; p = 0.049)

limb location (OR

2.22; p = 0.023) and hematoma evacuation (OR

2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR

3.88; p = 0.015) and hematoma evacuation (OR

10.35; p = 0.001) were so related to high risk of treatment failure.ConclusionsThe rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of <1 year

expander volume of >200 ml

limb location and postoperative hematoma evacuation were independent risk factors for expander infection.

关键词

Keywords

Tissue expansionTissue expanderScar reconstructionRisk factorsInfection

references

1.Neumann CG. The expansion of an area of skin by progressive distention of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear. Plast Reconstr Surg (1946). 1957; 19: 124–30.

2.Radovan C. Breast reconstruction after mastectomy using the temporary expander. Plast Reconstr Surg. 1982; 69: 195–208.

3.Ogawa R. Surgery for scar revision and reduction: from primary closure to flap surgery. Burns Trauma. 2019; 7:7. https://doi.org/10.1186/s41038-019-0144-5.

4.Min P, Li J, Brunetti B, Pu Z, Su W, Xi W, et al. Pre-expanded bipedicled visor flap: an ideal option for the reconstruction of upper and lower lip defects postburn in Asian males. Burns Trauma. 2020. https://doi.org/10.1093/burnst/tkaa005.

5.Finnerty CC, Jeschke MG, Branski LK, Barret JP, Dziewulski P, Herndon DN. Hypertrophic scarring: the greatest unmet challenge after burn injury. Lancet. 2016; 388: 1427–36.

6.Bayat A, McGrouther DA, Ferguson MW. Skin scarring. BMJ. 2003; 326: 88–92.

7.Sen CK, Gordillo GM, Roy S, Kirsner R, Lambert L, Hunt TK, et al. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009; 17: 763–71.

8.Khansa I, Harrison B, Janis JE. Evidence-based scar management: how to improve results with technique and technology. Plast Reconstr Surg. 2016; 138: 165S–78S.

9.Ma X, Li Y, Li W, Liu C, Peng P, Song B, et al. Reconstruction of large Postburn facial-scalp scars by expanded Pedicled Deltopectoral flap and random scalp flap: technique improvements to enlarge the reconstructive territory. J Craniofac Surg. 2017; 28: 1526–30.

10.Azzi JL, Thabet C, Azzi AJ, Gilardino MS. Complications of tissue expansion in the head and neck. Head Neck. 2020; 42: 747–62.

11.Huang X, Qu X, Li Q. Risk factors for complications of tissue expansion: a 20-year systematic review and meta-analysis. Plast Reconstr Surg. 2011; 128: 787–97.

12.Patel PA, Elhadi HM, Kitzmiller WJ, Billmire DA, Yakuboff KP. Tissue expander complications in the pediatric burn patient: a 10-year follow-up. Ann Plast Surg. 2014; 72: 150–4.

13.Motamed S, Niazi F, Atarian S, Motamed A. Post-burn head and neck reconstruction using tissue expanders. Burns. 2008; 34: 878–84.

14.As'adi K, Emami SA, Salehi SH, Shoar S. A randomized controlled trial comparing endoscopic-assisted versus open neck tissue expander placement in reconstruction of post-burn facial scar deformities. Aesthetic Plast Surg. 2016; 40: 526–34.

15.Tang S, Wu X, Sun Z, Cheng H, Shen H, Tang L, et al. Staged reconstructive treatment for extensive irregular cicatricial alopecia after burn. Medicine (Baltimore). 2018. https://doi.org/10.1097/MD.0000000000013522.

16.Abellan Lopez M, Serror K, Chaouat M, Mimoun M, Boccara D. Tissue expansion of the lower limb: retrospective study of 141 procedures in burn sequelae. Burns. 2018; 44: 1851–7.

17.Tayyaba FU, Amin MM, Attaur-Rasool S, Naseer U, Ambar A. Reconstruction of post burn scalp alopecia by using expanded hair-bearing scalp flaps. Pak J Med Sci. 2015; 31: 1405–10.

18.Adler N, Elia J, Billig A, Margulis A. Complications of nonbreast tissue expansion: 9 years experience with 44 adult patients and 119 pediatric patients. J Pediatr Surg. 2015; 50: 1513–6.

19.Margulis A, Billig A, Elia J, Shachar Y, Adler N. Complications of post-burn tissue expansion reconstruction: 9 years experience with 42 Pediatric and 26 adult patients. Isr Med Assoc J. 2017; 19: 100–4.

20.Hanna KR, Tilt A, Holland M, Colen D, Bowen B, Stovall M, et al. Reducing infectious complications in implant based breast reconstruction: impact of early expansion and prolonged drain use. Ann Plast Surg. 2016; 76: S312–5.

21.Smolle C, Tuca A, Wurzer P, Spendel SM, Forbes AA, Spendel S, et al. Complications in tissue expansion: a logistic regression analysis for risk factors. Burns. 2017; 43: 1195–202.

22.Fochtmann A, Keck M, Mittlböck M, Rath T. Tissue expansion for correction of scars due to burn and other causes: a retrospective comparative study of various complications. Burns. 2013; 39: 984–9.

23.Nguyen KT, Hanwright PJ, Smetona JT, Hirsch EM, Seth AK, Kim JY. Body mass index as a continuous predictor of outcomes after expander-implant breast reconstruction. Ann Plast Surg. 2014; 73: 19–24.

24.Ota D, Fukuuchi A, Iwahira Y, Kato T, Takeuchi M, Okamoto J, et al. Identification of complications in mastectomy with immediate reconstruction using tissue expanders and permanent implants for breast cancer patients. Breast Cancer. 2016; 23: 400–6.

25.Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250: 187–96.

26.Bjornson LA, Bucevska M, Verchere C. Tissue expansion in pediatric patients: a 10-year review. J Pediatr Surg. 2019; 54: 1471–6.

27.Karimi H, Latifi NA, Momeni M, Sedigh-Maroufi S, Karimi AM, Akhoondinasab MR. Tissue expanders; review of indications, results and outcome during 15 years' experience. Burns. 2019; 45: 990–1004.

28.Gold MH, McGuire M, Mustoe TA, Pusic A, Sachdev M, Waibel J, et al. Updated international clinical recommendations on scar management: part 2--algorithms for scar prevention and treatment. Dermatol Surg. 2014; 40: 825–31.

29.Monstrey S, Middelkoop E, Vranckx JJ, Bassetto F, Ziegler UE, Meaume S, et al. Updated scar management practical guidelines: non-invasive and invasive measures. J Plast Reconstr Aesthet Surg. 2014; 67: 1017–25.

30.Sue GR, Sun BJ, Lee GK. Complications after two-stage expander implant breast reconstruction requiring reoperation: a critical analysis of outcomes. Ann Plast Surg. 2018; 80: S292–4.

31.Lei J, Hou C, Duan P, Hao Z, Zhai Y, Meng Y. Clinical application of modified skin soft tissue expansion in early repair of devastating wound on the head due to electrical burn. Zhonghua Shao Shang Za Zhi. 2015; 31: 406–9.

32.Essebag V, Verma A, Healey JS, Krahn AD, Kalfon E, Coutu B, et al. Clinically significant pocket hematoma increases long-term risk of device infection: BRUISE CONTROL INFECTION study. J Am Coll Cardiol. 2016; 67: 1300–8.

33.Cheung EV, Sperling JW, Cofield RH. Infection associated with hematoma formation after shoulder arthroplasty. Clin Orthop Relat Res. 2008; 466: 1363–7.

34.Ostaszewska A, Wszola M, Olszewska N, Karpeta E, Serwanska-Swietek M, Kuthan R, et al. Reoperation in early kidney post-transplant period as a strong risk factor of surgical site infection occurrence. Transplant Proc. 2019; 51: 2724–30.

35.Hinds PR, Wilson SK, Sadeghi-Nejad H. Dilemmas of inflatable penile prosthesis revision surgery: what practices achieve the best outcomes and the lowest infection rates? (CME). J Sex Med. 2012; 9: 2483–91.

36.Zhu M, Zhang D, Ye X, Ma X, Guo X. Risk factors of infection after skin soft tissue expansion. Zhonghua Zheng Xing Wai Ke Za Zhi. 2019; 35: 986–90.

37.Azadgoli B, Fahradyan A, Wolfswinkel EM, Tsuha M, Magee W, 3rd, Hammoudeh JA, et al. External port tissue expansion in the Pediatric population: confirming its safety and efficacy. Plast Reconstr Surg. 2018; 141: 883e–90e.

38.Thabane L, Mbuagbaw L, Zhang S, Samaan Z, Marcucci M, Ye C, et al. A tutorial on sensitivity analyses in clinical trials: the what, why, when and how. BMC Med Res Methodol. 2013. https://doi.org/10.1186/1471-2288-13-92.

39.Sessler DI, Imrey PB. Clinical research methodology 2: observational clinical research. Anesth Analg. 2015; 121: 1043–51.

40.Chang H, Zhou B, Cui X, Su Y, Ma X. Analysis of the bacteria spectrum and clinical treatment of topical skin infection during soft tissue expander implantation. Zhonghua Zheng Xing Wai Ke Za Zhi. 2016; 32: 191–5.

41.Wei M, Liu YJ, Li ZL, Wang ZG, Zhu JL. Clinical effect of arthroscopic debridement and infusion-drainage on septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Zhongguo Gu Shang. 2015; 28: 279–81.

查看原文

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Consensus on the treatment of second-degree burn wounds (2024 edition)

Activating autophagy promotes skin regeneration induced by mechanical stretch during tissue expansion

The impact of COVID-19 on clinical outcomes of burn patients

Epidemiological and clinical characteristics of burns in the older person: a seven-year retrospective analysis of 693 cases at a burn center in south-west China

The pathogenesis and diagnosis of sepsis post burn injury

Related Author

Cross-Straits Medicine Exchange Association of China

Chinese Burn Association Tissue Repair of Burns and Trauma Committee

Zhaofan Xia

Shichu Xiao

Shizhao Ji

Jing Du

Wei Liu

Yajuan Song

Related Institution

Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University

Key Laboratory of Aerospace Medicine of Ministry of Education

Fourth Military Medical University

Department of Surgery, University of Texas Medical Branch

Division of Plastic

⁰