Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2020; 8(11): 2181-2189
Published online Jun 6, 2020. doi: 10.12998/wjcc.v8.i11.2181
Application of a pre-filled tissue expander for preventing soft tissue incarceration during tibial distraction osteogenesis
Hui Chen, Xing Teng, Xiao-Hua Hu, Lin Cheng, Wei-Li Du, Yu-Ming Shen
Hui Chen, Xiao-Hua Hu, Lin Cheng, Wei-Li Du, Yu-Ming Shen, Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
Xing Teng, Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China
Author contributions: Chen H, Teng X, Hu XH, Cheng L, Du WL, and Shen YM contributed to the writing and revising of the manuscript; all authors proofed the revised version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Beijing Jishuitan Hospital.
Informed consent statement: Patients were not required to give informed consent as the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu-Ming Shen, MD, Professor, Chief, Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, No. 31 Xinjiekoudong Street, Xicheng District, Beijing 100035, China. shenyumingjst@126.com
Received: March 14, 2020
Peer-review started: March 14, 2020
First decision: April 14, 2020
Revised: April 19, 2020
Accepted: May 13, 2020
Article in press: May 13, 2020
Published online: June 6, 2020
Abstract
BACKGROUND

Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery, but, skin and soft tissue incarceration can be as high as 27.6%.

AIM

To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.

METHODS

Between January 2016 and December 2018, 12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position. A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis. The tissue expander was removed when the two ends of the tibial defect were close enough.

RESULTS

In all 12 patients, the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis. When bone transport was adequate, the expander was removed and the bone transport process was completed. During the whole process, there was no incarceration of skin and soft tissue in the bone defect area. Complications occurred in one patient, who experienced poor wound healing.

CONCLUSION

The pre-filled expander technique can effectively avoid soft tissue incarceration. The authors’ primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.

Keywords: Tissue expander, Tibial defect, Bone transport, Skin and soft tissue incarceration, Distraction osteogenesis

Core tip: Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery, but skin and soft tissue incarceration can be as high as 27.6%. Skin and soft tissue incarceration often occurs in the late stage of bone transport. Considering that there is currently no ideal solution, the authors devised a new method to prevent the possible formation of skin and soft tissue incarceration using a tissue expander.