Tissue expanders in complex pediatric spine deformity

To describe the use of tissue expansion (TE) as an adjunct for management of tenuous soft tissue envelopes in children with complex spine deformities.

Single institution, retrospective review of patients (minimum 2-year follow-up) who had TE for management of spinal deformity prior to posterior spinal fusion (PSF) between 1997 and 2021. Demographics, clinical, and radiographic data were reviewed. Complications were classified using the Clavien-Dindo system (Grade 3 defined as requiring unplanned return to the operating room [UPROR]) and noted if related to the TE or PSF.

Twenty patients were included. Fifteen of the 20 patients had a diagnosis of myelomeningocele (MM), and 7 of the 20 patients (all who had MM) had an open wound at the time of TE placement. Six of the 7 patients (86%) with an open wound and 5 of 13 patients (38%) without an open wound experienced a Grade 3 complication (p=0.07). Of the 11 patients with Grade 3 complication, 1 patient had UPROR related only to TE, 9 patients had an UPROR related to PSF, and 1 patient had UPRORs related to TE and PSF.

Tissue expansion can be a useful adjunct in the management of complex spine deformities associated with poor soft tissue envelopes. Patients should be counseled of the high probability of UPROR.