TISSUE EXPANSION IN CHILDREN - A RETROSPECTIVE STUDY OF COMPLICATIONS

We retrospectively reviewed 105 consecutive children in whom 191 tissu e expanders were placed by the Plastic Surgical Service at The Childre n'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 tiss ue expansion were congenital pigmented nevus (N = 55), craniofacial an omaly (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 s calp (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 we re given preoperative intravenous antibiotics. There were 25 complicat ions in 20 patients (19%), which comprised 13% of all expanders. The m ost common complications were infection (6%, N = 11), deflation (3%, N = 6), and exposure (2%, N = 5). These complication rates were not rel ated to either the gender, site of implantation, number of expanders, use of closed suction drains, or the indication far expansion. The com plications were related to age, being higher in children (age 1-12 yea rs) compared with infants and adolescents. Tissue expanders can be suc cessfully used in children to construct and reconstruct a variety of c utaneous defects, but there is an irreducible minimum for the three ma jor complications.