Versatility of tissue expansion in head and neck burn reconstruction

Tissue expansion has enjoyed a wide range of applications since the technique was popularized by Radovan in 1978. A useful application of tissue expansion is in the reconstruction of the head and neck following burn injury. From July 1986 to March 1990, 25 patients underwent head and neck reconstruction for burn injury using tissue expanders. A retrospective chart review was undertaken. The average age was 24 years, and the age range was 9 months to 46 years. Fourteen males and 11 females were treated. A total of 51 expanders were placed, and the most common locations of the expanders were the cheeks, neck, and scalp. The time period from burn injury to reconstruction averaged 22.7 months. Operative time for placement of the expanders ranged from 40 to 180 minutes. The average time for full expansion was 86 days. Major complications were those that required an additional operative procedure, and included one dehiscence, one infection, and one port failure. The major complication rate was 12%. Minor complications were those that did not interrupt the expansion process or require any operative intervention. The minor complication rate was 32%, and included three cases of exposure, three cases of wound dehiscence, one seroma, and one ruptured implant. Minor complications were frequent, although when managed conservatively they did not compromise the overall outcome. Despite a major complication rate of 12%, final reconstruction was achieved in all patients. This retrospective review demonstrates that tissue expansion is a versatile adjunct in the treatment of burn injuries to the head and neck, and reconstruction in this area can be accomplished with excellent cosmetic results.