Expanded full-thickness skin grafts in children: case selection, planning, and management

Area of Science:

• Plastic Surgery
• Pediatric Reconstruction
• Tissue Engineering

Background:

• Tissue expansion has been utilized for harvesting large skin grafts since 1987.
• The technique's application has expanded to address diverse reconstructive challenges in pediatric patients.

Purpose of the Study:

• To evaluate the efficacy and outcomes of using expanded full-thickness skin grafts in pediatric reconstructive surgery.
• To assess the range of applications and graft sizes achievable with tissue expansion in children.

Main Methods:

• Retrospective review of 16 pediatric patients undergoing reconstruction with expanded full-thickness skin grafts.
• Grafts were harvested from expanded donor sites including groin, lower abdomen, clavicular, and submental areas.
• Follow-up ranged from 6 months to 6.5 years.

Main Results:

• Harvested grafts ranged from 60 cm² to over 700 cm².
• Successful reconstructions were achieved for giant nevus excision, postburn defects, facial coverage, breast reconstruction, hand/finger coverage, and lower extremity reconstruction.
• Minimal graft loss (6.25 cm² on cheek, 9 cm² on plantar surface) and negligible donor-site complications were reported.

Conclusions:

• Expanded full-thickness skin grafts are a viable and effective reconstructive option in children.
• The technique allows for large graft harvests while maintaining graft characteristics and achieving good aesthetic and functional results.
• Careful planning for expander placement and potential serial expansion is crucial for optimal outcomes in pediatric patients.