Home Versus Clinic Tissue Expansion in Children: Comparative Analysis of Outcomes and Complications
Donald B. Johnson, MD, Brittany Lapin, Ph.D, Bruce S. Bauer, MD.
NorthShore University HealthSystem, Northbrook, IL, USA.
Purpose: Tissue expansion is an important reconstruction option despite relatively high complication rates. Some have suggested that restricting expansion to a clinical setting may reduce complication rates; however, the available data is inadequate. This study sought to compare complication risks and outcomes between pediatric patients who underwent tissue expansion in the clinic and at-home.
Methods: A database of 288 consecutive patients (<18 years old), expanded between 2010 and 2016, was retrospectively reviewed for complications (measures: infection, exposure, seroma/hematoma, expander failure) and expansion outcomes (measures: complete, partial, failed). For comparative analysis, subjects were stratified by two groups: at-home and clinic expansion.
Results: 535 rounds of tissue expansion were analyzed. Of these, 85.4% rounds were completed by patients at home. There was no difference between groups with respect to expanders per subject or antibiotic rate; patients expanded in the clinic were slightly older (years, 3.8 vs. 3.0, p<0.016). The overall complication rate was 15.9% (n=85). Despite complications, 59.2% were successfully expanded; this rate was identical between groups (p<0.571). Patients expanded remotely were less likely to experience major complications (15.3% vs. 19.2%) or achieve suboptimal expansion (12.3% vs. 13.8%); however, these were not statistically significant (p<0.354 and 0.585, respectively).
Conclusions: Our data show that patients expanded at home are at no greater risk for complications than those expanded in a clinical setting. Furthermore, patients expanded at home demonstrated a highly likelihood of achieving expansion objective. On the basis of these finding, at-home tissue expansion should be considered a suitable alternative to clinical facilitation.
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