Tissue Expander Complications in the Pediatric Burn Patient: A 10 Year Follow-up

Purpose: This study is a 10-year follow-up to our previous publication reviewing the complication rates of tissue expansion in the pediatric burn population. Based on our experience from 1984 to 1995, we were able to reduce our absolute complication rate through maturation in surgical judgment, improved patient selection, perioperative preparation, surgical wound care and operative technique. The purpose of this study was to determine if our institutional experience with tissue expanders had further improved through our protocol change over a subsequent 10 years. Methods and Materials: There were 256 patients identified at a major pediatric burn center that underwent reconstruction with a tissue expander from 1996 to 2006. Data was obtained retrospectively by reviewing patient medical records. Complications were categorized into absolute and relative complications. Absolute complications were defined as premature expander loss resulting in further surgery or an inability to complete the preoperative plan. Relative complications were defined as subjectively poor preoperative judgment resulting in only partial completion of the preoperative plan. Absolute complications included (1) infection, (2) trauma, (3) exposure of the expander, (4) expander product failure, and (5) lost expander port. Relative complications included patients that had (1) inadequate tissue after expansion to cover the defect, (2) greater than 50 percent alopecia, and (3) only partial completion of the preoperative plan. The operative areas included the head and neck, scalp, and the anterior and posterior thorax. Results: Between the years 1996 and 2006 a total of 256 patients had expanders placed. The mean age was 11.1 years. Absolute complications occurred in 36 patients (14.0%) and relative complications occurred in 26 patients (10.1%). The complication rates for our previous study were 11% and 7% for absolute and relative complications respectively and this difference was not significant. The highest absolute and relative complication rates were for expanders of the scalp, which were 27 (10.5%) and 18 (7.0%) respectively. This was also true for our previous study. Conclusion: In comparing the data from the years 1984 to 1995 and 1996 to 2006, the absolute and relative complication rates increased. This difference was not statistically significant. After changing our tissue expander protocol, the complication rates at our institution have remained relatively stable over a 10-year follow-up period.