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External Port Tissue Expansion in the Pediatric Population: Confirming Its Safety and Efficacy

Azadgoli, Beina, M.S.; Fahradyan, Artur, M.D.; Wolfswinkel, Erik M., M.D.; Tsuha, Michaela, B.S.; Magee, William III, M.D., D.D.S.; Hammoudeh, Jeffrey A., M.D., D.D.S.; Urata, Mark M., M.D., D.D.S.; Howell, Lori K., M.D.

Plastic and Reconstructive Surgery: June 2018 - Volume 141 - Issue 6 - p 883e-890e
doi: 10.1097/PRS.0000000000004372
Pediatric/Craniofacial: Original Articles
Patient Safety CME

Background: External filling ports in tissue expander–based reconstruction have the advantages of being associated with less pain and emotional distress. However, among practicing surgeons using tissue expansion, a theoretical concern remains regarding higher risk of infection. The authors’ goal was to evaluate external port safety in the pediatric population by looking at the complications and overall success rate of reconstruction.

Methods: A retrospective review of all patients undergoing tissue expansion using external ports at Children’s Hospital Los Angeles between January of 2008 and June of 2016 was conducted. Patient demographic and perioperative data were collected and analyzed.

Results: Two hundred forty-one expanders were placed in 100 pediatric patients, resulting in 123 procedures for congenital and acquired conditions, with an average age at the time of surgery of 7.1 years (range, 1 month to 19.9 years) and average follow-up length of 2.5 years (range, 2.8 months to 8.8 years). The overall complication rate was 29.9 percent, and the infection rate was 17 percent. The majority of these cases were treated conservatively without additional need for surgery. Of 123 cases, 25 required premature expander removal because of complications. Despite early intervention, 21 of these cases underwent successful completion of their reconstruction according to the preoperative plan, resulting in an overall 96.7 percent success rate of tissue expander reconstruction.

Conclusions: In children, who are often less tolerant of the pain and distress associated with internal port expansion, the authors encourage the use of external ports. This study found a high success rate in terms of successful reconstruction, with the majority of complications being treated conservatively.


Los Angeles, Calif.

From the Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California; and the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles.

Received for publication July 13, 2017; accepted December 19, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Artur Fahradyan, M.D., Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, University of Southern California, 4560 Sunset Boulevard, Suite 96, Los Angeles, Calif. 90027,

Copyright © 2018 by the American Society of Plastic Surgeons