Experience with an external valve in small volume tissue expanders

The use of tissue expansion in children with burns of the head and neck

The outcome of 25 children who underwent reconstruction of the head and neck with tissue expanders is described. Fourteen boys and 11 girls with a mean age of 6.2 years (range 3-11 years) had 36 tissue expanders inserted. Five of the expanders extruded and five children suffered other expander-related complications. The best aesthetic results were achieved in the scalp and the poorest results occurred where expanded neck skin was transposed into the face. Tissue expansion is a useful method for reconstruction of the head and neck in burned children. However patients require careful selection in order to achieve optimal results. Meticulous attention to detail is required to reduce the incidence of complications.

Skin expansion. Long term follow up of complications and costs of care

To find out our rate of complications after tissue expansion, and the cost of treatment in terms of use of hospital resources and length of sick leave, we analysed our experience of 181 expansion treatments in 97 patients undertaken between 1986 and 1991. There were 60 women and 37 men, with a mean age of 22 (range 1-74). Twenty patients had more than one period of treatment (range 2-8). The most common conditions treated were naevi (n = 75); scars (trauma--n = 33, burns--n = 17, and operations--n = 16); and breasts that required reconstruction (n = 15). Of the 181 expansions there were 29 failures (16%), and 117 complete successes (64%); fifteen of the latter developed minor complications (8%), 35 were partly successful (20%). There were 77 complications in 71 treatments (38%), and 45 expanders (25%) had to be removed prematurely because of complications. The most common complications were skin penetration (n = 15), minor infection (n = 13), and breakdown of the surgical wound (n = 13). The median (range) inpatient hospital stay was 8 days (2-39); number of visits to the outpatient clinic for filling 7 days (0-20); and total treatment time/patient 82 (19-286). We conclude that skin expansion is a useful technique, but that there is room for improvement in reducing the rate of complications and the amount of time that patients spend being treated.

Tissue expansion: past, present, and future

The history of tissue expansion, technique, indications, and complications are reviewed. A detailed review of delayed tissue expansion's histologic, biochemical, biomechanical, and physiologic changes in the skin is given. There is a net gain in epidermal tissue during delayed expansion. Recent experimental and clinical experience suggests that expansion for 1 to 2 weeks is just as effective as longer delayed expansion for 6 to 8 weeks. A new deviation from standard technique, intraoperative tissue expansion, may have significant implications for dermatologic surgery. Intraoperative tissue expansion is explored in relation to other commonly used techniques of intraoperative load cycling.