BACKGROUND: Plastic surgeons are often faced with the difficult task of reconstructing large cutaneous defects. Skin tissue expansion provides an excellent option for closure of these wounds. Unfortunately, the complication rate with open tissue expander placement is quite high. One potential alternative to reduce these complications and improve recovery time is to place the tissue expanders endoscopically. The benefits of minimally invasive operations have been well-defined in the literature and include shorter hospital stays, reduced pain, and overall faster recovery times. We hypothesize that the same benefits are possible with endoscopic placement of tissue expanders, including reductions in operative time, time to full expansion, and complications. METHODS: Seventy-three patients underwent soft tissue reconstructions utilizing 173 tissue expanders over the past 5 years at the University of Michigan Health Systems. The charts for all patients were retrospectively reviewed and the data analyzed to evaluate outcomes following open and endoscopic tissue expander placement. RESULTS: 60 patients underwent open placement of 127 expanders for reconstruction, while 13 patients underwent placement of 46 tissue expanders endoscopically. The indications for placement of the tissue expanders using both techniques were large skin defects following trauma, burns, cutaneous tumors (squamous cell carcinoma, basal cell carcinoma), hernias, necrotizing fasciitis, chronic wounds, and giant congenital nevi. The average operative time for placement of each tissue expander was significantly reduced in the endoscopic group (32.1 minutes) as compared to the open group (49.2 minutes) (p<0.0001). The major complication rate per tissue expander was also reduced in the endoscopically-placed expander group (2.2% of expanders experienced a major complication) as compared to the open group (22.0% of expanders experienced a major complication) (p<0.0001). In fact, 30% of patients undergoing open tissue expander placement ultimately required removal of a tissue expander as a result of extrusion or infection, while only one of the endoscopically-placed tissue expanders required removal. The average operative time per case was less in the open group (107.4 minutes) as compared to the endoscopic group (129.1 minutes) due to the smaller number of expanders placed in each patient in the open group. The time to full expansion tended to be less in the endoscopically placed tissue expander group (107.1 days) as compared to the open group (128.8 days), but these differences were not statistically significant (p=0.15). CONCLUSIONS: Endoscopic placement of tissue expanders significantly reduced operative time for placement of each expander and dramatically reduced the major complication rate for this reconstructive technique. Based upon this information, we conclude that endoscopic placement of tissue expanders is a safe and effective method for reducing complications and decreasing operative time for tissue expander reconstructions of large, difficult wounds.
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