IS SOFT-TISSUE EXPANSION IN LOWER-LIMB RECONSTRUCTION A LEGITIMATE OPTION

From 1986 to 1994, a consecutive series of 34 patients had 37 expander s placed in their legs, Indications for expansion included removal of painful or unstable scars, chronic post-traumatic ulcers and one benig n skin lesion, In 13 patients the lesion or scar was greater than 5 cm in diameter, The area of expansion was mainly in the proximal and dis tal thirds of the lower limb, On three occasions two expanders were si multaneously used in the same patient, The treatment with this techniq ue was ultimately successful in 23 patients (67.6%) but 15 of the 23 p atients (44% of the 34 patients) had minor wound healing problems, Bef ore 1990, technical complications such as leaking injection ports caus ed further small interventions in 6 patients without compromising the ultimate outcome, The goal was not achieved with the expansion techniq ue in 11 patients (32%), 5 of these 11 patients could be treated succe ssfully with another surgical modality, All 34 patients were re-evalua ted with an average follow-up of 4.5 years. We conclude that tissue ex pansion is ideal for removal of localised areas of scar, repair of con tour defects and excision of benign tumours, Contraindications of soft tissue expansion are, in general, extensive scarred areas with compro mised blood supply after trauma, vascular disease and osteomyelitis. T hese conditions require reconstruction with well vascularised tissue s uch as muscle flaps, A compliant patient is essential for lower limb r econstruction with tissue expansion. In spite of the tempting simple m ethod of tissue expansion, success in the lower limb depends not only on the indication but also on the operating technique of the plastic s urgeon.