DOKU GENİŞLETİCİ UYGULAMALARINDA KOMPLİKASYONLARIN AZALTILMASI

Yıl 2011, Cilt: 19 Sayı: 2, 82 - 87, 01.08.2011

Cenk Demirdöver Haluk Vayvada Hasan Güç Mustafa Yılmaz

Öz

Giriş: Doku genişletme, yumuşak doku defektinin primer olarak kapatılamadığı durumlarda komşu dokuların bir balon yardımıyla genişletilmesi esasına dayanan bir rekonstrüksiyon yöntemidir. Birçok avantaja sahip olmasına karşın bazı prensiplere uyulmadığı takdirde yüksek komplikasyon oranı ile karşılaşılabilir. Gereç ve Yöntem: Bu çalışmada, 2006 - 2011 yılları arasında (5 yıl) kliniğimize başvuran ve doku genişletici kullanılan 59 hastaya ait veriler sunulmaktadır. Bulgular: Hastaların 37’si kadın (%63) 22’si erkek (%37) olup yaşları 6 ile 63 arasında değişmekteydi (ortalama 26,6). Kullanılan toplam 83 doku genişleticinin 41’i (%49,4) baş boyun bölgesi; 18’i (%21,7) gövde; 13’ü (%15,7) meme ve 11’i (%13,2) de ekstremite rekonstrüksiyonunda kullanılmıştır. Hastaların 18’ine (%30,5) birden fazla doku genişletici kullanılmıştır. Defekti tam olarak kapatılamayan 7 hastaya (%11,8) reekspansiyon uygulanmıştır. Hastaların ortalama izlem süresi 23,7 aydır (6-43 ay). Majör komplikasyon olarak hastaların 6’sında (%10,1) enfeksiyon ve 2’sinde (%3,3) ekspozisyon gözlenmiştir. Sonuçlar: Doku genişletici uygulamaları sırasında belli prensiplere dikkat edildiği takdirde hem hasta memnuniyeti hem de mevcut defektin kapatılması açısından iyi sonuçlar alınabileceği kanaatindeyiz.

Anahtar Kelimeler

doku genişletici, rekonstrüksiyon

REDUCING COMPLICATIONS in TISSUE EXPANDER APPLICATIONS

Öz

Introduction: Tissue expansion is a reconstructive technique based on expanding adjacent tissues using a silicone balloon to attain an optimal aesthetic and functional result using local tissue when primary closure of a soft tissue defect is not possible. Although this technique has many advantages, a high complication rate may be seen when basic principles are not followed. Material and Methods In this study, data of 59 tissue expander patients who admitted to our clinic between 2006 and 2011 (5 years) are presented. Thirty seven were females (63%) and 22 males (37%), with an average age of 26.6 years (ranging between 6 and 63 years). Results: Of the total number of 83 tissue expanders, 41 (49.4%) in head and neck; 18 (21.7%) in trunk; 13 (15.7%) in breast; and 11 (13.2%) in extremity reconstruction were used. Eighteen (30.5%) patients had multiple expanders. Reexpansion procedure was applied for seven (11.8%) patients in whom the defect could not be covered completely. The mean follow-up time was 23.7 months (ranged between 6 and 43 months). Infection and exposition were seen in 6 and 2 patients (10.1 and 3.3%) respectively, as a major complication. Conclusions: We believe that if certain principles are followed in tissue expansion procedures, good results may be obtained in terms of patient satisfaction as well as the reconstruction of the defect.

Anahtar Kelimeler

tissue expander, reconstruction

Kaynakça

• 1. Marks ML, Argenta JL, Thronton JW. Burn management The role of tissue expansion.Clin Plast Surg 1987;14:543-48.
• 2. Zellweger G, Künzi W: Tissue expanders in reconstruction of burn sequale. Ann Plast Surg 1991;26:380-88
• 3. Bozkurt A, Groger A, O’Dey D, Vogeler F, Piatkowski A, Fuchs PC, Pallua N. Retrospective analysis of tissue expansion in reconstructive burn surgery: Evaluation of complication rates Plast Surg. 2008: 1113 -8.
• 4. Manders EK, Schenden MJ, Furrey JA:Soft-tissue expansion: Concept and complications. Plast Reconst. Surg. 1984;74:493-507.
• 5. Neale HW, Kurtzman LC, Goh K BC, Billmire DA, Yakuboff KP, Warden G:Tissue expanders in the lower face and anterior neck in pediatric burn patients:Limitations and pitfalls Plast Reconstr Surg 1993;91:624-31.
• 6. MA Plant, CG Scilley, M Speechley. Single-stage immediate breast reconstruction using a skin-sparing incision and definitive saline implants compared with a two-stage reconstruction using tissue expansion plus implants. Can J Plast Surg 2009;17(4):117-23.
• 7. Rappard JHA, Molenaar J, van Doorn K, Sonneveld GJ, Borghouts JMHM. Surface-area increase in tissue expansion. Plast Reconst Surg 1988;82:833-7.
• 8. Dotan L, Icekson M, Yanko-Arzi R, Ofek A, Neuman R, Margulis A. Isr Med Assoc J. Pediatric Tissue Expansion: Our Experience with 103 Expanded Flap Reconstructive Procedures in 41 Children 2009 Aug;11(8):474-9.
• 9. Nordstrom RE. “Stretch-back” in scalp reductions for male pattern baldness. Plast Reconstr Surg. 1984;73(3):422-6.
• 10. Hudson DA, Grob M :Optimising results with tissue expansion:10 simple rules for successful tissue expander insertion. Burns 2005;31:1-4.
• 11. Bauer BS. Invited discussion for giant congenital nevi: a 20 year experience and an algorithm for their management. Plast Reconstr Surg 2001; 108: 632.6.
• 12. Maxwell GP, Falcone PA. Eighty-four consecutive breast reconstruction using a textured silicone tissue expander. Plast Reconstr Surg 1992; 89: 1022-34.
• 13. Ahmed Elshahat.Management of burn deformities using tissue expanders:A retrospective comparative analysis between tissue expansion in limb and non-limb sites. Burns, Volume 37, Issue 3, May 2011, Pages 490-4.
• 14. Keskin M, Tosun Z, Savaci N. An easy way to externalize the filling port of a tissue expander. Ann Plast Surg. 2006; 57; 478-9.
• 15. Tavares Filho JM, Belerique M, Franco D, Porchat CA, Franco T. Tissue expansion in burn sequelae repair. Burns 2007;33(2):246– 51.
• 16. Pitanguy I, Amorin NFG, Radwanski HN, Lintz JE. Repeat expansion in burn sequela. Burns 2002;28:494–9.
• 17. Atabey A, Barutçu A. Some useful techniques for avoiding complications of tissue expansion. Plast Reconstr Surg. 1994;94(6):897-9.