title: A Randomized Controlled Trial Comparing Endoscopic-Assisted Versus Open Neck Tissue Expander Placement in Reconstruction of Post-Burn Facial Scar Deformities.
abstract: BACKGROUND
  Tissue expansion has evolved reconstruction surgery by providing a great source of additional tissue for large skin defects. Nevertheless, wide application of tissue expander reconstruction is challenging due to high complication rates and uncertainty about final outcomes. Recently, endoscopy has shown promise in reconstructive surgeries using tissue expander placement.
  
  
  OBJECTIVE
  This study aimed to compare outcomes between open and endoscopic-assisted neck tissue expander placement in reconstruction of post-burn facial scar deformities.
  
  
  METHODS
  Through a randomized clinical trial, 63 patients with facial burn scars were assigned to an open group or endoscopic group for placement of 81 tissue expanders. The complication rate, operative time, length of hospital stay, and time to full expansion were compared between the two groups.
  
  
  RESULTS
  Thirty-one patients were assigned to the open group and 32 patients to the endoscopic group. The average operative time was significantly reduced in the endoscopic group compared with the open group (42.2 ± 3.6, 56.5 ± 4.5 min, p < 0.05). The complication rate was significantly lower in the endoscopic group than the open group (6 vs. 16, p < 0.05). Hospital stay was also significantly diminished from 26.3 ± 7.7 h in open group to 7.4 ± 4.5 h in endoscopic group (p < 0.0001). There was a significant reduction in time to full expansion in the endoscopic group as compared with the open group (93.5 ± 10.2 vs. 112.1 ± 14.2 days, p = 0.002).
  
  
  CONCLUSIONS
  Endoscopic neck tissue expander placement significantly reduced operative time, the postoperative complication rate, length of hospital stay, and time to achieve full expansion and allowed early initiation of expansion and remote placement of the port in relation to the expander pocket.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic and Reconstructive Surgery, St Fatima Hospital, Iran University of Medical Sciences, Suite 2, Afra Tower, Khashayar Park, Africa Blvd., Tehran, 1915683913, Iran. dr.kamran.asadi@gmail.com.|Burn Research Center, Motahari Burn Hospital, Iran University of Medical Sciences, Tehran, Iran. dr.kamran.asadi@gmail.com.
authors.forename: Kamran
authors.initials: K
authors.lastname: As'adi
authors.affiliation: Department of Plastic and Reconstructive Surgery, St Fatima Hospital, Iran University of Medical Sciences, Suite 2, Afra Tower, Khashayar Park, Africa Blvd., Tehran, 1915683913, Iran.|Burn Research Center, Motahari Burn Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Abolhassan
authors.initials: SA
authors.lastname: Emami
authors.affiliation: Burn Research Center, Motahari Burn Hospital, Iran University of Medical Sciences, Tehran, Iran.|Department of General Surgery, Motahari Burn Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Hamid
authors.initials: SH
authors.lastname: Salehi
authors.affiliation: Burn Research Center, Motahari Burn Hospital, Iran University of Medical Sciences, Tehran, Iran.|Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Shoar
mesh_terms: D000328:Adult; D002056:Burns / Q000150:complications* / Q000601:surgery; D002921:Cicatrix / Q000209:etiology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods; D004954:Esthetics; D005151:Facial Injuries / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009334:Neck Muscles / Q000098:blood supply / Q000637:transplantation*; D061646:Operative Time; D061214:Patient Safety; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D015626:Tissue Expansion / Q000009:adverse effects / Q000379:methods*; D015625:Tissue Expansion Devices / Q000706:statistics & numerical data; D014945:Wound Healing / Q000502:physiology
keywords: Endoscopic assisted; Facial burn; Neck tissue expansion