Abstract.

Tissue expansion has become the mainstay of treatment for resurfacing of large cutaneous defects in our pediatric burn patients. In this study, we retrospectively reviewed 368 consecutive expander placements between 1997 to 2006, at Shriners Hospital for Children of Northern California. A critical analysis of 9 years experiences at this institution showed an overall complication rate of 18% in pediatric population. This is lower than those previously reported (20% to 40%) and is similar to the adult population. The patients in this series included 51% male, and 49% female with the mean age of 12 years old, all of which had burn injury (85 % < 50 % and 15 % > 50 % TBSA burn). The expanders were placed in the scalp (N =116), face (N = 37), neck (N =69), ear (N= 2), anterior trunk (N = 104), posterior trunk (N = 17), buttock (N = 5), arms (N = 7), legs (N = 11). All patients received perioperative IV antibiotic and 1 week oral antibiotic post-op. We began the expansion process 2-3 weeks post-op in clinic. The tissue expanders were overfilled to 2-3 times the expander volume over 2-4 months. The overall complication rate is 18 % (67 out of 368 expanders). The major complications were infection (N=19, 28 %), leak (N=17, 25 %), wound breakdown (N=16, 24 %), extrusion (N=9, 13 %), and malrotation/trauma (N=6, 9 %). Our experience indicated that tissue expansion in pediatric burn patients has the same risks and benefits as in adult. The complication is not related to age, sites, or the number of expanders. Hence, we recommend that tissues expansion can be the gold standard in reconstructive surgery in pediatric burn patients at our institution.