Tissue expansion used as a method of reconstructive surgery in childhood

Tissue expansion has developed as an important routine procedure in plastic and reconstructive surgery in the past two decades. It is used progressively in cases of reconstruction treatment for children and adults who do not have enough adjacent tissue for reconstruction of the skin surface that is defective as a result of a trauma, burns, or congenital deformation. When applied to children, the method of tissue expansion enabled us to achieve aesthetic and functional results that had not been obtained before with traditional procedures of reconstructive surgery. This paper presents the results of tissue expansion in 62 children in the period 2000-2006 treated in the Burns and Plastic Surgery Centre in Sofia, Bulgaria. Seventy expanders with different forms and different volumes varying from 50-1000 ml were used as treatment according to the specific goals for reconstruction. The indications for using tissue expanders for children were the following: skin and soft-tissue defects after deep burns and injuries, traumatic defects, and pigmented stains. The children in this study of tissue expansion were 39 boys and 23 girls. The higher percentage (64%) of injured boys was due to the higher occurrence of traumatism among boys. The anatomical areas subjected to tissue expansion in relation to the reconstruction of the primary tissue defects were as follows: scalp, face, neck, mental area, breast area, sacral area, back, and upper and lower extremity. More than one tissue expander was placed in the same area in five children during a single operational phase. We observed functional recovery and excellent aesthetic results in 85% of the patients who underwent the tissue expansion treatment. The lowest percentage of complications was reported in the group of children aged 4-7 yr, i.e. 3.22%.