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Tissue Expander Infections in Pediatric Patients: Management and Outcomes

Adler, Neta M.D.; Dorafshar, Amir H. M.D.; Bauer, Bruce S. M.D.; Hoadley, Susan B.S.N.; Tournell, Mim B.S.N.

Plastic and Reconstructive Surgery: August 2009 - Volume 124 - Issue 2 - p 484-489
doi: 10.1097/PRS.0b013e3181adcf20
Reconstructive: Head and Neck: Original Articles

Background: Tissue expansion has become a well-established method for soft-tissue reconstruction in the pediatric population; however, the complication rate is still high, with infection being the most common complication. This study looks at a segment of the authors’ cases over a 4-year period to document the incidence of infection, impact on completing the planned expansion, and how the treatment impacted the completion of goals.

Methods: A database of 215 children who underwent reconstruction with tissue expanders from August of 2004 to August of 2008 at Children’s Memorial Hospital in Chicago, Illinois, was reviewed with respect to tissue expander infection cases. All patients were operated on by the senior author (B.S.B). All of the patients with tissue expander infection were analyzed, with emphasis on management and outcome.

Results: Fifteen children, one of them with infection during two different stages of the reconstruction [total of 16 cases (7.4 percent)], had tissue expander infection (5 percent of the total number of expanders). Expansion was continued after diagnosis of infection in all but three cases (two of them had simultaneous extrusion), with a median of six total expansions per child (range, four to 11 expansions) and two additional expansions from the time of infection (range, zero to eight additional expansions). In only one case did the early removal of the expander affect the successful reconstruction.

Conclusion: Tissue expander infection in children does not seem to preclude further expansion and successful reconstruction.

Chicago, Ill.

From the Division of Pediatric Plastic Surgery, Children’s Memorial Hospital.

Received for publication September 26, 2008; accepted February 2, 2009.

Disclosure: None of the authors has a financial interest in any of the products or devices mentioned in this article.

Bruce S. Bauer, M.D., Pediatric Plastic Surgery, NorthShore University HealthSystem, Highland Park Hospital, Suite 3464, 718 Glenview Avenue, Highland Park, Ill. 60035,

©2009American Society of Plastic Surgeons