title: Wound complications of vertical expandable prosthetic titanium rib incisions.
abstract: METHODS
  Multicenter retrospective review.
  
  
  OBJECTIVE
  To compare the incidence of infection between vertical expandable prosthetic titanium rib (VEPTR) incision locations and determine if the infection risk increases in relation to presence of previous incisions and/or increased number of times incisions are opened.
  
  
  BACKGROUND
  Patients undergoing treatment for chest and spine deformity with VEPTR require multiple incisions that are opened repeatedly during expansion procedures.
  
  
  METHODS
  A prospective database (7 sites) and institutional database (2 sites), were queried to identify their 20 most recent patients with VEPTR with a minimum of 4 expansions for inclusion. A total of 103 patients were identified. Clinical and operative reports were reviewed to determine incision locations, number, and infection complications.
  
  
  RESULTS
  Twenty-five of 103 patients (24%) developed an infection during treatment. Six had multiple infections (range, 2-4), providing a total of 34 infection events. Patients averaged 6.4 expansion procedures and 13 total incisions. Infection rate at each incision site was not significantly different, in the range from 1% to 5%: paramedian (6 infections/23 patients with total 185 incisions, 3%), proximal midline (12/39; 224, 5%), thoracotomy (6/61; 455, 1%), iliac (5/37; 143, 4%), and distal midline (5/58; 148, 3%). Infection events occurred after an average of 3 times a particular incision was opened (95% confidence interval: 2.2-3.8). There was a trend toward higher infection rate with increased number of times a particular incision was opened. There was no increased infection rate in patients with surgical incisions prior to VEPTR (26%; 6/23) compared with patients not having prior incisions (24%; 19/80).
  
  
  CONCLUSIONS
  The incidence of infection in patients with 4 or more VEPTR lengthenings was 24% and did not differ across the various incision locations. Presence of prior surgical incisions was not a risk factor for infection. Surgeons should use the most appropriate incision in relation to their patient's pathology when using VEPTR while remaining vigilant for infection.
  
  
  METHODS
  3.
authors.affiliation: *Children's Hospital Colorado, Aurora, CO; †University of Colorado, Denver, CO; ‡Chest Wall and Spine Deformity Research Foundation, Layton, UT; §Boston Children's Hospital, Boston, MA; ¶C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI; ‖Primary Children's Medical Center, Salt Lake City, UT; and **The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Garg
authors.forename: Jaren
authors.initials: J
authors.lastname: LaGreca
authors.forename: Tricia
authors.initials: T
authors.lastname: St Hilaire
authors.forename: Dexiang
authors.initials: D
authors.lastname: Gao
authors.forename: Michael
authors.initials: M
authors.lastname: Glotzbecker
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.forename: John T
authors.initials: JT
authors.lastname: Smith
authors.forename: Jack
authors.initials: J
authors.lastname: Flynn
mesh_terms: D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D019736:Prostheses and Implants / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000209:etiology*; D012131:Respiratory Insufficiency / Q000601:surgery; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D018570:Risk Assessment; D013122:Spinal Diseases / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology*; D013908:Thoracotomy / Q000009:adverse effects; D014025:Titanium / Q000009:adverse effects*
chemical_list: D014025:Titanium