Tissue Expansion in Children

Background: Tissue expansion has allowed plastic surgeons to achieve both functional and aesthetic reconstructive goals with tissues of similar color, thickness, and texture. It has become a major modality in reconstruction and has gained widespread application in the past 30 years. Tissue expansion is particularly applicable in the pediatric population as it is well tolerated during their daily activities. Aim and Objective: Clinical application of tissue expansion for reconstruction in the pediatric population at Tzu-Chi hospital was reviewed and the results are delineated. Materials and Methods: A retrospective study was performed from July 1995 to August 2009. There were 12 patients who had undergone 20 surgical procedures. A total of 32 tissue expanders were placed. There were 8 males and 4 females, with their ages ranging from 10 months to 16 years old. The indications for tissue expansion were burn scar contracture in 4 patients, burn scar alopecia in 2 patients, a pair of xipho-omphalopagus conjoined twins for separation, 1 patient with lymphedema receiving scrotal area reconstruction, 1 patient with widely excised malignant hemangioendothelioma, 1 patient with traumatic scar alopecia and 1 patient with residual arterio-venous malformation. The numbers and location of tissue expanders implanted were; 16 in the chest, 6 in the scalp, 7 in the thigh, 2 in the forearm and 1 in the neck. The complication rates and the clinical results were analyzed to evaluate the outcome of tissue expansion in this group of patients. Results: All patients tolerated the expansion procedure well either on an outpatient or inpatient basis. Tissue expander extrusion that necessitated removal occurred 3 times. One case developed wound infection. Debridement was carried out, the expander was removed and the expansion procedure was postponed. A total of 4 tissue expanders were removed. Two episodes of partial skin necrosis at the wound edge occurred in one patient. The wound was debrided and primary wound closure was done. The expansion course continued smoothly once the wound had healed completely. The overall complication rate was 18.75%. Eleven out of 12 children ultimately achieved fair to good results. Conclusion: Tissue expansion in the pediatric population has a similar complication rate when compared to adults. Children tolerate the procedure well and the tissue expander can well withstand the child's daily activities. With proper patient selection, thorough perioperative planning and meticulous technique, tissue expansion provides healthy tissues for surgeons to achieve a good reconstructive result with minimal donor site morbidity in children.