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Tissue expansion in children: a retrospective study of complications
L A Gibstein1, D L Abramson, R A Bartlett
1Division of Plastic Surgery, Children's Hospital at Harvard Medical School, Boston, MA USA.
Insights
Tissue expanders are effective for pediatric reconstruction, though complications like infection and deflation occur. Complication rates are higher in children aged 1-12 years compared to infants and adolescents.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Tissue expansion is a reconstructive technique used for various pediatric cutaneous defects.
- A retrospective review was conducted to evaluate the outcomes of tissue expander use in children.
Purpose of the Study:
- To assess the safety and efficacy of tissue expanders in pediatric patients.
- To identify the types and rates of complications associated with tissue expander use in children.
- To determine factors influencing complication rates in pediatric tissue expansion.
Main Methods:
- Retrospective review of 105 pediatric patients who underwent 191 tissue expander placements between 1987 and 1995.
- Data collected included patient demographics, indications for expansion, expander location, number of expanders, and complication types.
- Statistical analysis was performed to identify factors associated with complications.
Main Results:
- A total of 191 tissue expanders were placed in 105 children for indications including congenital nevi, craniofacial anomalies, and post-tumor resection.
- The overall complication rate was 19% (20 patients), with infection (6%), deflation (3%), and exposure (2%) being the most common.
- Complication rates were not associated with gender, site, number of expanders, or drain use, but were higher in children aged 1-12 years.
Conclusions:
- Tissue expanders are a viable option for reconstructing pediatric cutaneous defects.
- While generally safe, complications such as infection, deflation, and exposure necessitate careful patient selection and management.
- Age is a significant factor, with younger children (1-12 years) experiencing higher complication rates.
Abstract:
We retrospectively reviewed 105 consecutive children in whom 191 tissue expanders were placed by the Plastic Surgical Service at The Children's Hospital from 1987 to 1995. The age range was 1 month to 28 years. The series included 68 females and 37 males. The indications for tissue expansion were congenital pigmented nevus (N = 55), craniofacial anomaly (N = 13), aplasia cutis congenita (N = 7), meningomyelocele (N = 7), posttumor resection (N = 5), unstable scar (N = 4), burn scar (N = 3), and miscellaneous disorders. The expanders were located in the scalp (N = 59), cervicofacial area (N = 23), back (N = 18), chest (N = 6), and extremities (N = 6). A single expander was used in 47 patients and the mean number of expanders per patient was 1.8. All patients were given preoperative intravenous antibiotics. There were 25 complications in 20 patients (19%), which comprised 13% of all expanders. The most common complications were infection (6%, N = 11), deflation (3%, N = 6), and exposure (2%, N = 5). These complication rates were not related to either the gender, site of implantation, number of expanders, use of closed suction drains, or the indication for expansion. The complications were related to age, being higher in children (age 1-12 years) compared with infants and adolescents. Tissue expanders can be successfully used in children to construct and reconstruct a variety of cutaneous defects, but there is an irreducible minimum for the three major complications.