The use of serial tissue expansion in pediatric plastic surgery

There are clinical situations in which even despite the use of simultaneous multiple tissue expanders, complete coverage of a defect cannot be achieve d. In this situation, serial, repeated tissue expansion may be indicated. T here are few studies that have reported repeated tissue expansion in pediat ric plastic surgery. Twelve children (6 girls, 6 boys) with a mean age of 7 years underwent serial tissue expansion for giant hairy nevus (N = 3) or b urn reconstruction (N = 9). A total of 63 tissue expanders were used. Seria l expansion of the expanded flap was performed a second time in 12 children , a third time in 6 children, and a fourth time in 2 children. The major co mplication rate was 4% for the first expansion, and 20%, 18%, and 0% for th e second, third, and fourth expansions respectively. Clinically, at the tim e of expander reinsertion, there was no evidence of capsule from the previo us expander in any patient. This was confirmed on histological examination of 12 biopsy specimens. Repeated tissue expansion is a safe and effective p rocedure for use in pediatric plastic surgery.