Complications of tissue expansion in a public hospital

Avoidance of complications in tissue expansion requires careful outpatient observation and consistent follow-up-two factors that are difficult to manage in a city hospital-based population. To determine the complication rate of tissue expanders in a given population, the authors reviewed retrospectively 34 tissue expanders placed in 30 patients at a New York City public hospital over a 7-year period from 1989 to 1996. The mean age of the patients at the time of insertion was 25 years (range, 11 months-65 years). The most common conditions for treatment were nevi (N = 11), burn scars (N = 8), breast reconstructions (N = 8), and spina bifida (N = 4). Complications occurred in 22 of 34 expanders (65%). Complications included deep infection (N = 11), exposure (N = 7), breakdown of the surgical wound (N = 4), cellulitis (N = 3), drainage (N = 1), and deflation (N = 1). Major complications resulted in premature removal in 13 of 34 expanders (38%). Minor complications leading to successful completion of the expansion process occurred with 9 of 34 expanders (27%). No complications were recorded in the remaining 12 of 34 expanders (35%). Although tissue expansion is a potentially safe and effective method of reconstruction, this review should alert the surgeon to the distinct challenges that may be encountered in the public hospital.