Tissue expansion of the lower limb: Retrospective study of 141 procedures in burn sequelae

Skin expansion in the lower limb is a difficult procedure with a significant rate of complications. We propose, in this retrospective mono centric study, a systematic review of our skin expansion procedures on the lower limb in burn sequelae with a 30-years follow-up. The objective was to evaluate the overall result of our procedure and present its technical specificities.

We have included all of our skin expansion procedure in burn sequelae of the lower limb that had ended at least 6 months ago. The primary study endpoint was the occurrence of a complication during the procedure. The surgical approaches were juxta-lesional. A juxta-lesion or radial incisions were made for remote valves. When prosthesis were removed, we performed advancement flaps.

From 1987 to 2017, we performed 141 lower limb expansions in 73 patients (62 women for 11 men). The average duration of the inflation procedure was 100.5 days. At least one complication occurred for 29.1% of procedures. We have identified 44 complications. Among the 41 complicated procedures, 26 procedures (63.4%) failed in the final achievement of an expanded skin flap and 15 procedures (36.6%) were rescued after complication, leading to perform flaps. We recorded 115 (81.6%) completed procedures.

The success of our expansion procedures in burn sequelae of lower limb is due to technical key points such as the choice of the prosthesis size, the position of the remote internal valve, the position of the drain and a delayed inflation start. Level IV.