Comparison of Complications and Patient Satisfaction between External and Internal Port of Tissue Expander

Background: Tissue expansion is a relatively straightforward procedure that enables the body to grow extra skin for use in reconstructing almost any part of the body. A silicone balloon expander is inserted under the skin, near the area to be repaired, and then gradually filled with salt water over time, causing the skin to stretch and grow. This procedure is most commonly used for breast reconstruction following breast removal, but it is also used to repair skin damaged by birth defects, accidents or surgery, and in certain cosmetic procedures. Two kinds of expanders are available for the above procedures: expander with external port and expander with internal port. This study was done in order to determine the prevalence of complications and patient satisfaction in surgery with internal and external port of tissue expander.Methods: This is a randomized clinical trial conducted in Alzahra and Imam Mousa Kazem hospitals, Isfahan, Iran, during 2008-2009. 76 patients who were candidates for tissue expansion were randomly divided into two groups. The patients in the first group were operated by the internal port, and the patients in the second group were operated by the external port of tissue expander. All patients were followed until the removal of the expander, and the complications of the expander were recorded. Moreover, patient satisfaction was measured at the end of study. Finally all data were analyzed by SPSS software.Findings: According to the results of this study the frequency distribution of tissue expansion complications in internal and external ports were 31.6% and 42.1%, respectively. No statistical differences were observed between the two groups (P = 0.34). Moreover, the overall patient satisfaction in internal and external ports were 70.2% and 78.9% respectively, and there was no statistical difference between the two groups (P = 0.81). Conclusion: In the internal port there is a necessity for another cavity (other than the space for the tissue expander), the port is placed under the skin, and the liquid is injected into the port during several sessions. In this method because the place of the port is not visible it results in the satisfaction of patients, however, the repeated injections cause discomfort for the patients, and increase the risk of complications such as skin infections. The external port method causes patient dissatisfaction due to its visibility and appearance. Therefore, it is best to survey the patients on the two expander methods after the patients are discharged from the hospital and the expander is removed.