Salvaging the Unavoidable: A Review of Complications in Pediatric Tissue Expansion. Issue 3 (September 2018)

• Record Type: Journal Article
• Authors: Gosain, Arun K.; Turin, Sergey Y.; Chim, Harvey; LoGiudice, John A.
• Is Part Of: Plastic and reconstructive surgery. Volume 142:Issue 3(2018:Sep.)
• Publication Date: 2018-09
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000004650
• Languages: English
• ISSNs: 0032-1052

Abstract

Abstract : Background: Tissue expansion, while a mainstay of reconstruction for pediatric cutaneous lesions, has significant complication rates. The authors review the complications in a single-surgeon series of tissue expansion to identify risk factors for complications and guide subsequent therapy so that reconstructive goals in patients can be met irrespective of intervening complications. Methods: A retrospective chart review was conducted of all pediatric patients who underwent tissue expansion performed by the senior author (A.K.G.) over a 12-year period. In total, 282 expanders were placed in 94 patients. Results: A total of 65 complications occurred in 39 of 94 patients (41.5 percent), involving 65 of the 282 expanders (23.0 percent) placed. Major complications that required expander removal included exposure ( n = 11), rupture ( n = 15), and migration ( n = 11). The most frequent minor complications, which did not require immediate expander removal, included migration ( n = 13) and port malfunction ( n = 9). The majority of expanders were placed in the scalp ( n = 114), followed by the torso ( n = 100), face and neck ( n = 52), and the extremities ( n = 16). Serial expansion beyond the second round resulted in a marked increase in complications. Despite complications, tissue expansion in the majority of patients could be salvaged, and a satisfactory outcome was achieved. Conclusions: Families must be made aware that approximately one-third of patients may have a complication requiring additional surgery or modification of the initial reconstructive plan. However, these complications need not preclude attainment of reconstructive goals. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. Abstract : Coding Perspective for this Article is on Page 767.