Faculty Collaboration Database

Salvaging the Unavoidable: A Review of Complications in Pediatric Tissue Expansion. Plast Reconstr Surg 2018 Sep;142(3):759-768

Date

08/28/2018

Pubmed ID

30148780

DOI

10.1097/PRS.0000000000004650

Scopus ID

2-s2.0-85059496716 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

BACKGROUND: Tissue expansion, while a mainstay of reconstruction for pediatric cutaneous lesions, has significant complication rates. The authors review the complications in a single-surgeon series of tissue expansion to identify risk factors for complications and guide subsequent therapy so that reconstructive goals in patients can be met irrespective of intervening complications.

METHODS: A retrospective chart review was conducted of all pediatric patients who underwent tissue expansion performed by the senior author (A.K.G.) over a 12-year period. In total, 282 expanders were placed in 94 patients.

RESULTS: A total of 65 complications occurred in 39 of 94 patients (41.5 percent), involving 65 of the 282 expanders (23.0 percent) placed. Major complications that required expander removal included exposure (n = 11), rupture (n = 15), and migration (n = 11). The most frequent minor complications, which did not require immediate expander removal, included migration (n = 13) and port malfunction (n = 9). The majority of expanders were placed in the scalp (n = 114), followed by the torso (n = 100), face and neck (n = 52), and the extremities (n = 16). Serial expansion beyond the second round resulted in a marked increase in complications. Despite complications, tissue expansion in the majority of patients could be salvaged, and a satisfactory outcome was achieved.

CONCLUSIONS: Families must be made aware that approximately one-third of patients may have a complication requiring additional surgery or modification of the initial reconstructive plan. However, these complications need not preclude attainment of reconstructive goals.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Author List

Gosain AK, Turin SY, Chim H, LoGiudice JA

Author

John A. LoGiudice MD Professor in the Plastic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Infant
Male
Postoperative Complications
Retrospective Studies
Risk Factors
Salvage Therapy
Tissue Expansion
Treatment Outcome