Advances in burn scar reconstruction: the use of tissue expansion

The use of tissue expansion to facilitate burn scar reconstruction is described. Twelve patients underwent burn scar reconstruction using a total of 42 expanders. Expansion was carried out at two- to three-day intervals, usually commencing as early as two to three days following insertion of the expander. In 5 of the 12 patients, previously scarred skin was expanded to facilitate excision of areas of more dense scarring and scar contractures, more conventional methods having previously failed. Two of the expanders failed to achieve adequate expansion because of exposure of the device. One of the patients in whom the expander failed refused to have it reinserted. Complications included implant exposure (9 of 42), injection port exposure (1 of 42), infection (4 of 42), and a transient facial nerve palsy in 1 patient who was having her cheeks expanded. Except for one case, implant exposure did not preclude continued expansion and ultimate reconstruction.