Pediatric tissue expansion: indications and complications

Tissue expansion has become a major reconstructive modality in the past 30 years. Its application in the pediatric population has allowed the plastic surgeon to achieve functional and esthetic goals that were previously unobtainable. Tissue expansion is a major treatment modality in the management of giant congenital nevi and secondary reconstruction of extensive burn scars, allowing sensate tissue of similar color, texture, and thickness to be used to resurface the affected areas. One must be prepared for complications when using tissue expanders, however, because complications are inherent in the process of expanding skin utilizing repeated filling of implanted foreign bodies. Complication rates increase when serial expansion of the same tissues is performed repeatedly or if expanders are placed in the lower extremities. Outcomes are dependent on thorough planning, meticulous technique, close follow-up, and patient compliance. Tissue expansion has revolutionized plastic surgery in the last 30 years. This technique can be applied to a considerable breadth of reconstructive problems in the pediatric population. Tissue expansion has permitted the plastic surgeon to achieve the goals of reconstruction with tissue of similar color, texture, and thickness, with minimal donor site morbidity. Preservation of sensation in a durable flap has allowed the surgeon to achieve acceptable functional as well as esthetic goals simultaneously.