Inflating Your Success: An Algorithmic Approach to Improving Outcomes in Pediatric Tissue Expansion

Tissue expanders (TEs) are vital for creating soft tissue for reconstruction. This study examines the challenges of pediatric TEs and proposes an algorithm to minimize complications and optimize outcomes.

A retrospective review (2014-2024) included patients younger than 18 years with TEs, excluding breast reconstruction cases. Initial TE fills were performed in-clinic 2 weeks postoperatively with parent education, whereas subsequent expansions were managed at home. Parents monitored for complications, started antibiotics, and scheduled urgent visits if needed. Data collected included demographics, TE characteristics, indications, defect size, and outcomes.

Forty pediatric patients (median age: 5.2 y) had 96 TEs placed. Most cases (62.5%) were for congenital skin lesions, followed by trauma/burns and surgical scars (each 12.5%). The scalp was the most common site for placement (39.6%). The median defect size was 306 cm² (interquartile range: 66-642 cm²), with a median of 2 TEs placed per patient (interquartile range: 2-3). Complications occurred in 35.4% of the TEs (20 patients), with 17.6% classified as early complications. Extrusion (17.7%) and infection (11.5%) were the most common complications. Although early removal was necessary for 33 TEs (34.4%), adequate tissue expansion and successful reconstruction were achieved in 92.5% of patients.

Despite a significant risk of complications, tissue expansion is effective for pediatric reconstruction. This study demonstrates the importance of early diagnosis and management of complications. Although early failures may require additional TE attempts, successful reconstruction remains achievable with many complications. A structured approach to managing TE-related complications is crucial for improving outcomes in pediatric patients.