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Salvaging the Unavoidable: A Review of Complications in Pediatric Tissue Expansion

Gosain, Arun K., M.D.; Turin, Sergey Y., M.D.; Chim, Harvey, M.D.; LoGiudice, John A., M.D.

Plastic and Reconstructive Surgery: September 2018 - Volume 142 - Issue 3 - p 759–768
doi: 10.1097/PRS.0000000000004650
Pediatric/Craniofacial: Original Articles
Discussion
Coding Perspective

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.

Coding Perspective for this Article is on Page 767.

Chicago, Ill.; Gainesville, Fla.; and Milwaukee, Wis.

From the Division of Plastic and Reconstructive Surgery, Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine; the Division of Plastic and Reconstructive Surgery, University of Florida; and the Department of Plastic Surgery, Medical College of Wisconsin.

Received for publication September 24, 2017; accepted March 1, 2018.

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

Arun K. Gosain, M.D., Division of Pediatric Plastic and Reconstructive Surgery, Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 93, Chicago, Ill. 60611, arun.gosain@northwestern.edu

©2018American Society of Plastic Surgeons