Tissue expansion of the lower limb: complications in a cohort of 103 cases

Over 10 years we performed 103 skin-expansion procedures and placed 207 pro stheses on lower limbs, using the same surgical protocol. In 83 cases (80.6 %) the expansion was achieved without complications. We recorded 20 complic ations in all (19.4%). Major complications included sepsis, damage due to u ndermining, exposure of the prosthesis and necrosis of the flap in 16 cases (15.5%), resulting in complete failure of the method in five cases (4.9%). In all, nine patients had septic complications (8.7% of the patients and 4 5% of the complications), five had exposure of the prosthesis and two had s kin necrosis after expansion. Infection and skin necrosis, which are the ma in causes of failure of this method, can be prevented by a strict surgical protocol covering all stages of the procedure. Atraumatic undermining, remo te and external valves, suction drains in the cavities, advancement flaps a nd plaster casts after surgery can help to prevent skin necrosis. A separat e and remote approach for each prosthesis can prevent infection of all the prostheses and complete failure of the expansion procedure. (C) 2001 The Br itish Association of Plastic Surgeons.