Tissue expansion in the pediatric patient: A 23-year single-institution experience

Given the wide and variable use of tissue expansion in pediatric soft tissue reconstruction, we aimed to characterize its use at our institution over the past 23 years, focusing on clinical outcomes stratified by location, indication, and repeat expansion.

A multi-surgeon retrospective review of all patients who underwent tissue expander (TE) placement from 2001-2024 was conducted. Demographic, operative, and outcomes data were collected and compared. Univariable and multivariable logistic regression were used to identify the predictors of complications and premature explantation.

Overall, 211 patients with 519 TEs met the inclusion criteria. The most common diagnoses were congenital nevus (21.8%, n=46), scarring (21.8%, n=46), and omphalocele (12.3%, n=26). Successful reconstruction was achieved in 93.4% of the patients (n=197); 22.7% (n=48) underwent repeat expansion of the same anatomic location. Complications occurred in 24.5% (n=127) of the expanders and 16% (n=82) required premature explantation. On multivariable analysis, use in conjoined twins (OR 2.6, p=0.006), use for wound reconstruction (OR 6.1, p=0.047), and repeat expansion (OR 2.5, p=0.008) were associated with increased odds of complications. Expander placement at <3.5 years was associated with increased odds of premature explantation (OR 1.9, p=0.047).

Although pediatric tissue expansion allows effective soft tissue reconstruction in a multitude of anatomic locations and conditions, it remains a significant undertaking for families and is not without risk. Repeat tissue expansion, use in conjoined twins, and wound reconstruction are predictive of increased complications. Placement at <3.5 years of age may also increase the odds of premature explantation.