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Intraoperative Acute Tissue Expansion: New Applications of Technique for Challenging Skin Defects
Anna M. Widmyer, Katherine L. Billue, A. Lawrence Cervino
Summa Health System
2015-03-14
Presenter: Kathryn Billue
Affidavit:
This is an original project compiling a single surgeon's experience with acute tissue expanders. It has not been presented at any other meetings or published in any journal, and no outside help was received on the project.
Director Name: Douglas Wagner
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background:
Tissue expansion allows reconstruction of large cutaneous defects without skin grafts or regional, distant, or microsurgical flaps. The efficacy of acute tissue expansion (ATE) is controversial with critics citing increased tension on closures, while proponents maintain that ATE is efficacious with low morbidity.
Objective:
To review a surgeon's experience with ATE, illustrate innovative uses of this technique for a variety of defects, and review adverse outcomes.
Methods:
Forty-six patients undergoing excision and closure of wounds in anatomical areas where primary closure was unachievable were identified and retrospectively reviewed. Data collected included patient demographics, pre and post-excision defect size, lesion histology, operative technique, and postoperative complications.
Results:
Charts from 2008-2014 were reviewed for a single surgeon. ATE was utilized in the following anatomical locations: lower third of leg, anterior pretibial region, forehead, scalp, back, forearm, neck, and thigh. The most common pathology was melanoma (58.6%) followed by basal cell carcinoma (23.9 %), squamous cell carcinoma, atypical nevi, dermatofibroma, and leiomyosarcoma. The post excision defect ranged from 1.5x6cm to 18.5x6.5cm with an average of 30.2cm2. Five patients experienced complications including wound dehiscence (4%), flap necrosis (2.5%), and cellulitis (4%). Obesity, diabetes, and smoking status were not associated with an increase in complications.
Conclusions:
ATE is a safe and efficacious technique to achieve skin closure at a variety of anatomic sites not amenable to primary closure. Novel uses of this technique allow coverage of large defects and the ability to preserve critical landmarks with low morbidity and high patient satisfaction.
