Endoscpoic Insertion of Tissue Expanders in Post Burn Scars: A Comparative Study between Endoscopic Versus Open Tissue Expansion at Post Burn Scars

Background: The use of endoscopic technology allows
for clearer visualization of the tissue-expander pocket, making
it possible to place more expanders in less time while maintaining
superior control. This results in improved hemostasis,
fewer infections, reduced complications, quicker expansion,
shorter hospitalization, and a decrease in post-operative complications.
Skin tissue expansion is a valuable option for the
reconstruction of large skin defects, though the procedure carries
a high rate of complications. An endoscopic approach for
placing tissue expanders may help lower complications rate
and shorten recovery time.
Objectives: In this study we will compare placement
of tissue expanders with aid of endoscopy versus traditional
open method for placement of tissue expanders to assess
safety, feasibility and adequacy of endoscopic tissue expander
placement.
Patients and Methods: This study, conducted prospectively,
involved 20 patients who were divided into two groups:
Group A, where 10 patients underwent endoscopic tissue expander
placement, and Group B, where 10 patients had the
traditional open approach. The procedures were carried out at
Menoufia University Hospital from June 2018 to December
2024. Patient charts were reviewed, and the data were assessed
to compare the outcomes of endoscopic versus open tissue expander
placement.
Results: Ten patients in this study had 13 tissue expanders
placed openly for reconstruction (3 with post burn cicatricial
alopecia (PBCA), 7 with post burn scars (PBS), in areas such
as the neck, chest wall, and limbs), and ten patients had 14
expanders placed endoscopically (7 with post burn cicatricial
alopecia, 3 with post burn scars in the face, chest wall, and
back). The open group average operating time was 75±5 minutes,
while the endoscopic group was 100±5 minutes. However,
the endoscopic group experienced a shorter hospital stay
(3-5 days compared to 5-9 days) and a shorter time to reach
full expansion (6-8 weeks versus 9-11 weeks). Additionally,
the endoscopic group experienced fewer major complications
than the open group.
Conclusions: The reconstructive technique of endoscopic
tissue-expander placement led to a shorter hospital stay, faster
expansion, and a lower rate of major complications. Endoscopic
placement is a safe and efficient technique for tissue-expander
reconstruction of various cosmetic lesions, according
to the study’s findings.