Complications in tissue expansion: A logistic regression analysis for risk factors

Christian Smolle, Alexandru Tuca, Paul Wurzer, Stephanie M. Spendel, Abigail A. Forbes, Stephan Spendel, Michael Schintler, Emir Haxhija, Katja Schwenzer-Zimmerer, Herwig Friedl, Lars Peter Kamolz, Daryousch Parvizi

    Research output: Contribution to journalArticle

    3 Citations (Scopus)

    Abstract

    Background: Tissue expansion is frequently used in reconstructive surgery. Although the surgical procedure is typically considered simple, reported complication rates of tissue expansions exceed 40%. There is little evidence concerning risk factors for complications in tissue expansion in body regions other than breast. The aim was to determine risk factors for complications in non-breast tissue expansion. Methods: 34 patients treated with subcutaneous tissue expanders between 2005 and 2014 were analyzed. Demographic data, body-mass index (BMI), mean arterial blood pressure (MAP), treatment indications, expansion site, previous expansion therapies in the same body region, smoking history, as well as expander characteristics (shape, volume, and filling mechanism) were ascertained. Complications were assessed and ranked according to severity based on the Clavien-Dindo classification. Binary logistic regression analysis adjusted for clinical characteristics was used. A p. <. 0.05 was considered as statistically significant. Results: Complications were observed in 26 out of 71 expanders analyzed (36.6%), of whom 10 led to therapy failure. Expanders used in the limbs, female gender, and high expander volume turned out as significant risk factors. Patients with both a high MAP and low BMI developed tissue necrosis significantly more often (p = 0.002). The use of tissue expansion after a burn was not associated with an increased risk for complications. Conclusions: This is the first study revealing female gender and low BMI as risk factors in tissue expander surgery. Thus, careful patient selection is mandatory to avoid complications in tissue expansion. Burn patients do not develop complications more often.

    Original languageEnglish (US)
    JournalBurns
    DOIs
    StateAccepted/In press - 2016

    Fingerprint

    Tissue Expansion
    Logistic Models
    Regression Analysis
    Arterial Pressure
    Tissue Expansion Devices
    Body Regions
    Body Mass Index
    Reconstructive Surgical Procedures
    Subcutaneous Tissue
    Patient Selection
    Breast
    Necrosis
    Therapeutics
    Extremities
    Smoking
    History
    Demography

    Keywords

    • Body mass index
    • Complication
    • Risk factor
    • Tissue expander

    ASJC Scopus subject areas

    • Surgery
    • Emergency Medicine
    • Critical Care and Intensive Care Medicine

    Cite this

    Smolle, C., Tuca, A., Wurzer, P., Spendel, S. M., Forbes, A. A., Spendel, S., ... Parvizi, D. (Accepted/In press). Complications in tissue expansion: A logistic regression analysis for risk factors. Burns. https://doi.org/10.1016/j.burns.2016.08.030

    Complications in tissue expansion : A logistic regression analysis for risk factors. / Smolle, Christian; Tuca, Alexandru; Wurzer, Paul; Spendel, Stephanie M.; Forbes, Abigail A.; Spendel, Stephan; Schintler, Michael; Haxhija, Emir; Schwenzer-Zimmerer, Katja; Friedl, Herwig; Kamolz, Lars Peter; Parvizi, Daryousch.

    In: Burns, 2016.

    Research output: Contribution to journalArticle

    Smolle, C, Tuca, A, Wurzer, P, Spendel, SM, Forbes, AA, Spendel, S, Schintler, M, Haxhija, E, Schwenzer-Zimmerer, K, Friedl, H, Kamolz, LP & Parvizi, D 2016, 'Complications in tissue expansion: A logistic regression analysis for risk factors', Burns. https://doi.org/10.1016/j.burns.2016.08.030
    Smolle, Christian ; Tuca, Alexandru ; Wurzer, Paul ; Spendel, Stephanie M. ; Forbes, Abigail A. ; Spendel, Stephan ; Schintler, Michael ; Haxhija, Emir ; Schwenzer-Zimmerer, Katja ; Friedl, Herwig ; Kamolz, Lars Peter ; Parvizi, Daryousch. / Complications in tissue expansion : A logistic regression analysis for risk factors. In: Burns. 2016.
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    abstract = "Background: Tissue expansion is frequently used in reconstructive surgery. Although the surgical procedure is typically considered simple, reported complication rates of tissue expansions exceed 40{\%}. There is little evidence concerning risk factors for complications in tissue expansion in body regions other than breast. The aim was to determine risk factors for complications in non-breast tissue expansion. Methods: 34 patients treated with subcutaneous tissue expanders between 2005 and 2014 were analyzed. Demographic data, body-mass index (BMI), mean arterial blood pressure (MAP), treatment indications, expansion site, previous expansion therapies in the same body region, smoking history, as well as expander characteristics (shape, volume, and filling mechanism) were ascertained. Complications were assessed and ranked according to severity based on the Clavien-Dindo classification. Binary logistic regression analysis adjusted for clinical characteristics was used. A p. <. 0.05 was considered as statistically significant. Results: Complications were observed in 26 out of 71 expanders analyzed (36.6{\%}), of whom 10 led to therapy failure. Expanders used in the limbs, female gender, and high expander volume turned out as significant risk factors. Patients with both a high MAP and low BMI developed tissue necrosis significantly more often (p = 0.002). The use of tissue expansion after a burn was not associated with an increased risk for complications. Conclusions: This is the first study revealing female gender and low BMI as risk factors in tissue expander surgery. Thus, careful patient selection is mandatory to avoid complications in tissue expansion. Burn patients do not develop complications more often.",
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    author = "Christian Smolle and Alexandru Tuca and Paul Wurzer and Spendel, {Stephanie M.} and Forbes, {Abigail A.} and Stephan Spendel and Michael Schintler and Emir Haxhija and Katja Schwenzer-Zimmerer and Herwig Friedl and Kamolz, {Lars Peter} and Daryousch Parvizi",
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    AU - Tuca, Alexandru

    AU - Wurzer, Paul

    AU - Spendel, Stephanie M.

    AU - Forbes, Abigail A.

    AU - Spendel, Stephan

    AU - Schintler, Michael

    AU - Haxhija, Emir

    AU - Schwenzer-Zimmerer, Katja

    AU - Friedl, Herwig

    AU - Kamolz, Lars Peter

    AU - Parvizi, Daryousch

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    N2 - Background: Tissue expansion is frequently used in reconstructive surgery. Although the surgical procedure is typically considered simple, reported complication rates of tissue expansions exceed 40%. There is little evidence concerning risk factors for complications in tissue expansion in body regions other than breast. The aim was to determine risk factors for complications in non-breast tissue expansion. Methods: 34 patients treated with subcutaneous tissue expanders between 2005 and 2014 were analyzed. Demographic data, body-mass index (BMI), mean arterial blood pressure (MAP), treatment indications, expansion site, previous expansion therapies in the same body region, smoking history, as well as expander characteristics (shape, volume, and filling mechanism) were ascertained. Complications were assessed and ranked according to severity based on the Clavien-Dindo classification. Binary logistic regression analysis adjusted for clinical characteristics was used. A p. <. 0.05 was considered as statistically significant. Results: Complications were observed in 26 out of 71 expanders analyzed (36.6%), of whom 10 led to therapy failure. Expanders used in the limbs, female gender, and high expander volume turned out as significant risk factors. Patients with both a high MAP and low BMI developed tissue necrosis significantly more often (p = 0.002). The use of tissue expansion after a burn was not associated with an increased risk for complications. Conclusions: This is the first study revealing female gender and low BMI as risk factors in tissue expander surgery. Thus, careful patient selection is mandatory to avoid complications in tissue expansion. Burn patients do not develop complications more often.

    AB - Background: Tissue expansion is frequently used in reconstructive surgery. Although the surgical procedure is typically considered simple, reported complication rates of tissue expansions exceed 40%. There is little evidence concerning risk factors for complications in tissue expansion in body regions other than breast. The aim was to determine risk factors for complications in non-breast tissue expansion. Methods: 34 patients treated with subcutaneous tissue expanders between 2005 and 2014 were analyzed. Demographic data, body-mass index (BMI), mean arterial blood pressure (MAP), treatment indications, expansion site, previous expansion therapies in the same body region, smoking history, as well as expander characteristics (shape, volume, and filling mechanism) were ascertained. Complications were assessed and ranked according to severity based on the Clavien-Dindo classification. Binary logistic regression analysis adjusted for clinical characteristics was used. A p. <. 0.05 was considered as statistically significant. Results: Complications were observed in 26 out of 71 expanders analyzed (36.6%), of whom 10 led to therapy failure. Expanders used in the limbs, female gender, and high expander volume turned out as significant risk factors. Patients with both a high MAP and low BMI developed tissue necrosis significantly more often (p = 0.002). The use of tissue expansion after a burn was not associated with an increased risk for complications. Conclusions: This is the first study revealing female gender and low BMI as risk factors in tissue expander surgery. Thus, careful patient selection is mandatory to avoid complications in tissue expansion. Burn patients do not develop complications more often.

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