Skin expansion in burn sequelae: results and complications

Before Radovan introduced skin expansion, burn sequelae were treated with skin grafts, local or distant flap, with an high morbidity on the donor site. Actually this technique is well known and standardized procedure that allows to obtain local flaps with the same characteristics in colour, texture, hair and sensitivity of the normal skin. The authors analyze their experience in the treatment of burn sequelae from 1985 to 1995. During this period, 157 patients underwent surgery to correct burn scars and contracture, utilizing 262 skin expanders. The implants were positioned on the fascial layer; antibiotic and drainage were routinely used. The inflation of the expander began 2 weeks after surgery, and hyperexpansion was the rule, when possible. Only in 6.4% (10 patients) expansion failed, while in the remaining cases good partial (in patients with too large scars) or total results were achieved. Complication rate in skin expansion is high. In this series complication occurred in 73 of 262 expansion, but 43 were easily solved. So only in 30 expansions the final outcome was influenced by complication, with higher incidence in neck and in lower extremities. Results were generally satisfactory, with an improvement of scars and minimal donor site morbidity. With a careful selection of the patients, skin expansion offers a good solution for burn sequelae, complications can be reduced and successfull results achieved.