Endoscopic versus open tissue-expander placement: is less invasive better?

Skin tissue expansion provides an excellent option for reconstruction of large cutaneous defects. Unfortunately, the complication rate with tissue-expander reconstruction is very high. One potential alternative to reduce these complications and improve recovery time is to place the tissue expanders endoscopically. The authors hypothesize that endoscopic placement of tissue expanders will reduce the complication rate, operative time, and time to full expansion.

Sixty-nine patients have undergone 81 surgical procedures for placement of 202 tissue expanders over the past 8 years at the University of Michigan Health System. The charts for all patients were reviewed retrospectively and the data analyzed to evaluate outcomes following open and endoscopic tissue-expander placement.

Fifty-one patients underwent open placement of 127 tissue expanders for reconstruction, whereas 18 patients underwent endoscopic placement of 75 expanders. The average operative time for placement of each expander was significantly reduced in the endoscopic group (34.0 minutes) compared with 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 (2.7 percent) compared with the open group (22.0 percent) (p = 0.0000056). Time to full expansion and length of hospital stay were also significantly reduced in the endoscopic group (p < 0.05 and p < 0.005, respectively).

Endoscopic tissue-expander placement significantly reduced operative time for placement of each expander, major complication rate, time to full expansion, and length of hospital stay for this reconstructive technique. The authors conclude that endoscopic placement of tissue expanders is a safe and effective method for tissue-expander reconstructions of large, difficult wounds.