Risk Factors for Postoperative Complications Following Tissue Expander-Based Reconstruction in Pediatric Burn Patients
Moreen Njoroge, Cynthia Yusuf, Matthew Heron, Bashar Hassan, Christopher Lopez, Robin Yang, Richard Redett
Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, USA
Tissue expansion has been widely used for reconstruction of soft tissue defects following burn injuries in pediatric patients, allowing for satisfactory cosmetic and functional outcomes. Factors impacting the success of tissue expander (TE)-based reconstruction in these patients are poorly understood. We aim to identify risk factors for postoperative complications in pediatric burn patients after TE-based reconstruction.
We conducted a retrospective review of pediatric patients who underwent tissue expander placement for reconstruction of burn injuries from 2006 to 2019. Primary outcomes included TE explantation, extrusion, replacement, readmission, wound complications (surgical site infection, wound dehiscence), and successful reconstruction (improved cosmetic and functional outcomes). Bivariate analysis evaluated the relationship between primary outcomes, patient demographics, and injury characteristics.
Of n=25 patients, the mean (standard deviation [SD]) age was 7.7 (4.4) years, and the median (interquartile range [IQR]) follow-up was 11.5 [3.0-26.0] months. Most patients were males (n=18 [72%]), Black patients (n=10 [40%]), and had flame burns (n= 7, [28%]). Compared to patients who did not develop major complications, those who did were significantly more likely to have higher total body surface area (TBSA) involved (median [IQR] TBSA (%): 9.5 [4.3-19.5], 35.0 [16.0-58.0], P=0.021). Patients with burn TBSA ≥30% were at increased risk of major complications compared to patients with burn TBSA <30% (n=4 [80.0%], n=2 [16.7%], P=0.028). Compared to those who did not develop wound complications, those who did were significantly more likely to be older (mean (SD) age in years: 6.5 (3.9), 10.4 (4.7), P=0.038) and have more than one body region involved (n=1 [5.9%], n=4 [50.0%], P=0.038).
Large TBSA involvement (e.g., TBSA ≥30%) and multiple affected body regions were linked to worse postoperative outcomes in pediatric burn patients undergoing TE-based reconstruction. These findings aid informed decision-making and optimal management for pediatric burn injuries.
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