Osmotic Tissue Expander – Experience in Ten Consecutive Pediatric Cases

Background: Osmotic tissue expander is a self-filling device containing osmotic hydro-gel which absorbs tissue fluids in order to increase skin volume gradually. It has unique characteristics: It absorbs fluids in the first 8-10 weeks after bodily insertion. It expands to a definite volume at a Consistent rate of pressure. The rate of expansion remains stable over time. Large variety of sizes and shapes of expanders allows for a convenient use in a wide spectrum of defects.

Purpose: We shall present our experience with 10 consecutive pediatric cases of tissue reconstruction using osmotic expanders. We wish to emphasize the main advantageous of this device in the pediatric population.

Methods and materials: Ten patients (7 females), median age of 10 years (range 6-15) have been reconstructed using an osmotic tissue expander since May of 2008. Indications for using tissue expander included large congenital nevi (80%) and scars. Areas of body treated were: scalp (20%), shoulder (20%), upper extremities (30%) and lower extremities (30%). In 80% of the patients one expander was used. In 20%, two expanders were used for each patient. Results: In all cases, the operative and post operative management was uneventful with no major complications. Minor complications included partial slough of the skin (1 patient) which was later cured. The average expansion period was 10 weeks (range 5-20). During that time, there were 2 (range 1-3) follow ups. Final aesthetic results were satisfactory in all cases.

Conclusion: Osmotic expander is a reliable tool for tissue expansion. The final shape and size are precisely predictable. Complications can be avoided by careful insertion of the expander in the correct plane, creating exact pocket size. The main advantages of this device make it especially suitable for children: Its initial small size allows for insertion through a small surgical incision. There is no need for a drain, and overall operating time is much shorter. The expansion period is more convenient for the patient. The need for external filling injections is eliminated and the risk of infections is lower. Its main disadvantages include the inability to control the filling rate and the necessity to remove it in case of damage to the skin overlying the expander.