Pediatric cervicofacial tissue expansion.

Keith A Hurvitz
Keith A Hurvitz
Calif. From Aesthetic and Reconstructive Plastic Surgery; and the Aesthetic and Plastic Surgery Institute
Beverly Hills | United States
Heather Rosen
Heather Rosen
Johns Hopkins Bloomberg School of Public Health
Baltimore | United States
Dr John G Meara, MD, DMD, MBA
Dr John G Meara, MD, DMD, MBA
Harvard Medical School
Plastic Surgeon-in-Chief
Cleft and Craniofacial Surgery
Boston, MA | United States

Int J Pediatr Otorhinolaryngol 2005 Nov;69(11):1509-13

University of California Irvine, Aesthetic and Plastic Surgery Institute, Irvine, CA, USA.

Introduction: Tissue expanders have long been used for reconstructing large cutaneous and fascio-cutaneous defects in children. Previous studies have examined tissue expansion for all body regions, touching upon the head and neck regions. We present a focused review of our experience with cervicofacial tissue expansion in the pediatric population.

Materials And Methods: We retrospectively reviewed 89 children who underwent tissue expansion of the head and neck regions at Children's Hospital of Los Angeles. Most patients underwent multiple expander placements bringing the total expander number to 182. Indications for expansion included congenital nevus [N=39], burn scar [N=14], hemangioma/lymphangioma/arteriovenous malformation [N=11], scar due to trauma [N=10], congenital anomaly [N=5], sebaceous nevus [N=3], cutis aplasia [N=2], tumor [N=2], infection [N=2] and scleroderma [N=1].

Results: Of the 182 expanders placed, 56 had an associated complication (30.8%). The most frequent complications included exposure, infection, leakage, migration, flap necrosis, wound separation, and skull bone remodeling. Expanders placed in the neck appeared to have the highest complication rate.

Conclusions: This retrospective review identified a high complication rate in pediatric cervicofacial tissue expansion, which is similar to previously published studies. Despite these findings, tissue expansion in pediatric patients should continue to remain a viable reconstructive option, however, proper patient selection; patient education and informed consent involving a discussion of the expected treatment course and risk profile should be undertaken.

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November 2005
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