"Pediatric Tissue Expansion: Predictors of Premature Expander Removal in A Single Surgeon's Experience with 472 Expanders"

• Published in: Plastic and reconstructive surgery (1963)
• Main Authors: Wang, Howard D, Ibrahim, Zuhaib, Quan, Amy, Bai, Jennifer, Ostrander, Benjamin T, Redett, Richard J
• Format: Journal Article
• Language: English
• Published: United States 01.03.2020
• ISSN: 1529-4242
• DOI: 10.1097/PRS.0000000000006550

Tissue expansion is an important technique for soft tissue reconstruction in pediatric patients. However, the expansion process can be complicated by infection and extrusion, leading to expander removal and reconstructive delays. The aim of this study was to identify risk factors associat0065d with premature expander removal due to infection or extrusion in pediatric patients. A retrospective study of all pediatric patients who underwent tissue expander insertion by the senior author over a twelve-year period was performed. Predictor variables included age, sex, race, indication, the anatomic location, the number of expanders inserted, serial expansion, and expander size. Bivariate and multivariate analyses were performed to identify risk factors for premature expander removal. A total of 139 patients with 472 expanders were included in this study. One or more complications occurred with 78 (16.5%) expanders. Overall, premature expander removal due to infection or exposure occurred with 51 (10.8%) expanders. In terms of location, the highest rates of premature removal occurred in the lower extremity (20.0%) and scalp (16.3%). Multivariate analysis identified that younger age (Age 0-6 compared to age 13-17: OR 3.98, CI 1.13 - 14.08, P=0.03), greater number of expanders inserted (OR 1.45, CI 1.03 - 2.03, P=0.03), and lower extremity location (OR 4.27, CI 1.45 - 12.53, P=0.008) were associated with an increased odds of premature expander removal. Infection or extrusion leading to expander removal occurred in approximately 10% of tissue expanders. Odds of premature removal is increased with younger age, greater number of expanders placed, and lower extremity location.