The Salvage of a Tissue Expander—an Updated Literature Review, a Classification and Illustrative Cases

• Published in: Indian journal of surgery Vol. 84; no. 2; pp. 262 - 270
• Main Authors: De La Cruz Monroy, Martha F. I., Arya, Reza, Rauf, Khawaja Gulraiz
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.04.2022; Springer; Springer Nature B.V
• Subjects: Analysis; Cardiac Surgery; Health aspects; Infection; Infections; Literature reviews; Medical care, Cost of; Medicine; Medicine & Public Health; Neurosurgery; Pediatric Surgery; Plastic Surgery; Reconstructive surgery; Review Article; Skin; Skin & tissue grafts; Surgery; Surgical outcomes; Thoracic Surgery; Infection; Extrusion; Salvage; Implant-based reconstruction; Tissue expansion
• ISSN: 0972-2068; 0973-9793
• DOI: 10.1007/s12262-021-02872-5

Tissue expansion is a key reconstructive strategy for certain anatomical areas. However, complications such as infection, skin necrosis and extrusion of expander may halt the expansion process ultimately leading to patient morbidity, stress and associated healthcare costs. We performed a systematic review of the literature following the PRISMA guidelines in order to identify tissue expander (TE) salvage strategies employed. We also present two cases complicated by infection and TE extrusion, in which “True TE Salvage” was achieved. We retrieved 18 articles published between 1989 and 2020. The most common anatomical location for TE reconstruction was the breast and the most common complication was infection. The calculated salvage success rate was 78% (94/120). We classified the TE salvage techniques into True Salvage, Open Salvage, Immediate Exchange Salvage, Delayed Exchange Salvage and TE failure. We present two cases of forehead expansion which were complicated by infection leading to skin necrosis and extrusion of TE. Case 1 was managed by continuous irrigation through a paediatric feeding tube and case 2 with repeat pocket lavage and external scrub. In both cases, with the “True TE Salvage” the infection resolved, the original TEs remained in situ and the expansion process and reconstruction were completed. Various TE salvage techniques and in particular the “True TE Salvage” should be considered an option for select patients. It offers numerous benefits including continuation of the reconstructive process and reduction of patient distress and healthcare costs. Our proposed classification will allow for a more consistent reporting and therefore facilitate future analysis.