Complications of tissue expansion in a public hospital

Avoidance of complications in tissue expansion requires careful outpatient observation and consistent follow-up--two factors that are difficult to man age in a city hospital-based population. To determine the complication rate of tissue expanders in a given population, the authors reviewed retrospect ively 34 tissue expanders placed in 30 patients at a New York City public:h ospital over a 7-year period from 1989 to 1996, The mean age of the patient s at the time of insertion was 25 years (range, 11 months-65 years). The mo st common conditions for treatment were nevi (N = 11), burn scars (N = 8), breast reconstructions (N = 8), and spina bifida (N = 4), Complications occ urred in 22 of 34 expanders (65%), Complications included deep infection (N = 11), exposure (N = 7), breakdown of the surgical wound (N = 4), cellulit is (N = 3), drainage(N = 1), and deflation (N = 1). Major complications res ulted in premature removal in 13 of 34 expanders (38%), Minor complications leading to successful completion of the expansion process occurred with 9 of 34 expanders (27%), No complications were recorded in the remaining 12 o f 34 expanders (35%), Although tissue expansion is a potentially safe and e ffective method of reconstruction, this review should alert the surgeon to the distinct challenges that may be encountered in the public hospital.