Role of tissue expansion in abdominal wall reconstruction: A systematic evidence based review

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2017-06, Vol.70 (6), p.741-751
• Main Authors: Wooten, Kimberly E., MD, Ozturk, Cemile Nurdan, MD, Ozturk, Can, MD, Laub, Peter, BS, Aronoff, Nell, MLS, Gurunluoglu, Raffi, MD, PhD
• Format: Article
• Language: English
• Subjects: Abdominal Wall - surgery; Abdominal wall reconstruction; Adult; Child; Component separation; Hernia, Ventral - surgery; Herniorrhaphy - adverse effects; Herniorrhaphy - methods; Humans; Plastic Surgery; Postoperative Care; Postoperative Complications; Recurrence; Reoperation; Risk Factors; Tissue expanders; Tissue expansion; Tissue Expansion - adverse effects; Tissue Expansion - methods; Transplantation; Ventral hernia
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2017.02.018

Summary Background Tissue expanders (TE) can be used to assist primary closure of; complicated hernias and large abdominal wall defects. However, there is no consensus; regarding the optimal technique, use or associated risk of TE in abdominal wall; reconstruction. Methods A systematic search of PubMed and EMBASE databases was conducted to identify articles involving abdominal wall reconstruction with TE techniques. English; language articles published between 1980 and 2016 were included based on the; following inclusion criteria: two-stage TE surgical technique, >3 cases, reporting of; post-operative complications, hernia recurrence and patient based clinical data. Results Fourteen studies containing 103 patients were identified for analysis. Patients consisted of 85 adults and 18 children. Most patients presented with a skin grafted; ventral hernia (n=86). The etiology of the hernia was from trauma or prior abdominal; surgery. The remaining patients had TE placed before organ transplantation (n=12), or; for congenital abdominal wall defects (n=5). The location for expander placement was subcutaneous (n=74), between internal and external obliques (n=26), posterior to rectus sheath (n=2) and intra-peritoneal (n=1). Postoperative infections and implant related problems were the most commonly reported complications after stage I. The; most common complication after stage II was recurrent hernia, which was observed in; twelve patients (11.7%). Five patients with TE died. Complications and mortality were; more prevalent in children, immunosuppressed patients and those with chronic; illnesses. Conclusions Tissue expansion for abdominal wall reconstruction can be successfully used for a variety of carefully selected patients with an acceptable complication and; risk profile.