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 Table of Contents    
ORIGINAL ARTICLE
Year : 2010  |  Volume : 43  |  Issue : 2  |  Page : 181-183
 

Port retrieval for salvage of tissue expansion in case of lost or malfunctioning port


Department of Plastic and Reconstructive Surgery, PGIMER & Dr. RML Hospital, New Delhi -110 001, India

Date of Web Publication3-Dec-2010

Correspondence Address:
Lalit K Makhija
1515, Outram lines, GTB Nagar, Delhi-110 009
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0358.73441

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 » Abstract 

Tissue expansion though a promising modality of reconstructive surgery is fraught with many complications. In addition to expander-related complications, subcutaneous port-related mishaps during tissue expansion, though infrequent, can result in procedure failures. We are reporting two patients with port-related complications. In one patient, there was failure to localise the port and the other had a leaking port. Both the expanders were salvaged by retrieving the ports. In the former, as the port was competent, it was simply exteriorised. But in the later case, the connecting tube was retrieved and the incompetent port was replaced with a Luer lock external port. Both the cases were successfully salvaged without any further complications. Expansions were completed and requisite reconstructive end points were achieved.


Keywords: Port complications; port retrieval; tissue expansion


How to cite this article:
Makhija LK, Jha MK, Bhattacharya S, Rai A, Mishra S, Dey A. Port retrieval for salvage of tissue expansion in case of lost or malfunctioning port. Indian J Plast Surg 2010;43:181-3

How to cite this URL:
Makhija LK, Jha MK, Bhattacharya S, Rai A, Mishra S, Dey A. Port retrieval for salvage of tissue expansion in case of lost or malfunctioning port. Indian J Plast Surg [serial online] 2010 [cited 2019 Jun 19];43:181-3. Available from: http://www.ijps.org/text.asp?2010/43/2/181/73441



 » Introduction Top


In tissue expansion, in addition to those complications related to the expanding silicone envelope, injection port has also been associated with some specific complications like exposure, lost port, port malfunction, dislocation and rotation. Instead of giving up on these expanders and loosing time and money or adding further morbidity, we feel that it is worth salvaging them without adding ay risk to the patients by addressing the port specific problems. [1]


 » Case Reports Top


Case 1

The "lost" port : A tissue expander with subcutaneous port was placed in the thigh for management of post traumatic scars. Later, we failed to locate the port owing to the thick subcutaneous tissue. Although we injected saline after localising the port by ultrasound, every time this exercise was not logistically feasible. Hence, we exteriorised the subcutaneous port after ultrasongraphic localisation. Tube site was dressed regularly and expander inflation was continued. The patient underwent expansion and reconstruction successfully [Figure 1]. [2]
Figure 1 :Case 1: Thigh scar; patient with exteriorised port after completion of expansion

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Case 2

The "malfunctioning" port : Tissue expanders were placed in cheek and forehead in a 15-year-old girl with giant congenital melanocytic nevus of face. After uneventful expansion for about 2 months, the port became incompetent leading to slow deflation of the expander following saline injection. In order to salvage the expander, the connecting tube was retrieved by giving a small incision leaving the original port in situ and an external "Luer" lock port was connected to the retrieved tubing [Figure 2]. Expansion with external port was continued with strict aseptic precautions. Reconstruction was completed successfully without any other untoward incident.
Figure 2 :Case 2: Exteriorised tube with Luer lock port with abandoned subcutaneous port in situ

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 » Discussion Top


Overall expander related complication rates in the literature range from 5 to 30%. [3],[4],[5] Such complications usually necessitate abandonment or modification of procedure. Numerous complications have also been associated with subcutaneous ports, including seroma, hematoma, skin erosion, port dislocation and port leakage. [6],[7],[8] Cunha et al. reported a port failure rate of 5.4% in their 10-year experience. [5] Port incompetence can be attributed to various factors. Multiple punctures of the port septum over a long period, especially with a wide bore needle, may cause the septum to wear out or dislodge small particles of the seal. Sometimes, if too much force is employed while introducing the needle in the port, the needle tip may bend by striking the metal base of the port and the hooked needle may tear the seal at time of withdrawal. This was probably the cause of port failure in the second case. We found multiple linear tears in the port on examination under magnification [Figure 3].
Figure 3 :Magnified view of the "leaking" port; multiple linear tears on the port cover

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There are few reports regarding use of external ports for tissue expansion. [6],[7],[8],[9],[10] Complication rates of primary external port placement range from 5.6 to 23%. [6],[7],[8],[9] In our patients, there was no expander infection after port exteriorisation. This could be due to the fact that body of expander and port tube assembly were in separate capsules at the time of exteriorisation and therefore we did not breach the expander pocket while exteriorising the port. Additionally, strict asepsis was also followed during exteriorisation and subsequent expansion.

There is a paucity of literature with regard to expansion salvage in face of lost or incompetent port. There are anecdotal references of ultrasonic localisation of a lost port, [11] but there is no report of port exteriorisation as solution. By this simple technique of port retrieval and replacement, precious expansion can be salvaged. Moreover, the expansion phase is not prolonged and added patient morbidity is obviated.

 
 » References Top

1.Neumann CG. The expansion of an area of the skin by progressive distention of subcutaneous balloon. Plast Reconstr Surg 1957;19:124-30.  Back to cited text no. 1
    
2.Radovan C. Tissue expansion in soft-tissue reconstruction. Plast Reconstr Surg 1984;74:482-92.  Back to cited text no. 2
[PUBMED]    
3.Adler N, Dorafshar AH, Bauer BS, Hoadley S, Tournell M. Tissue expander infections in pediatric patients: management and outcomes. Plast Reconstr Surg 2009;124:484-9.   Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Manders EK, Schenden MJ, Furrey JA, Hetzler PT, Davis TS, Graham WP 3 rd . Soft-tissue expansion: Concepts and complications. Plast Reconstr Surg 1984;74:493-507.   Back to cited text no. 4
    
5.Cunha MS, Nakamoto HA, Herson MR, Faes JC, Gemperli R, Ferreira MC. Tissue expander complications in plastic surgery. a 10 year experience. Rev Hosp Clin Fac Med Sao Paulo 2002;57:93-7.   Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Jackson IT, Sharpe DT, Polley J, Costanzo C, Rosenberg L. Use of external reservoirs in tissue expansion. Plast Reconstr Surg 1987;80:266-73.  Back to cited text no. 6
[PUBMED]    
7.Atabey A, Barutηu A. Some useful techniques for avoiding complication of tissue expansion. Plast Reconstr Surg 1994;94:897-9.  Back to cited text no. 7
    
8.Keskin M, Kelly CP, Yavuzer R, Miyawaki T, Jackson IT. External filling ports in tissue expansion: confirming their safety and convenience. Plast Reconstr Surg 2006;117:1543-51.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Lozano S, Drucker M. Use of tissue expanders with external ports. Ann Plast Surg 2000;44:14-7.  Back to cited text no. 9
[PUBMED]    
10.Nahai F. A method for exteriorization of tissue expander tubing. Plast Reconstr Surg 1988;82:723-4.  Back to cited text no. 10
    
11.Sellers DS, Miller S, Miller SH, Demuth RJ, Bocchi, J. Use of ultrasound to locate a "lost" tissue expander injection port. Plast Reconstr Surg 1986;78:250-1.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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