Cervicofacial Pediatric Tissue Expansion: A Single Surgeon’s 16-Year Experience & Aesthetic Unit-Based Algorithm
Christopher D. Lopez, MD1, Cynthia T. Yusuf, BS1, Alisa O. Girard, MA1, Alexander K. Karius, BS1, Robin Yang, MD DDS1, Howard D. Wang, MD2, Richard J. Redett, MD1.
1Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Division of Plastic Surgery, Case Western University School of Medicine, Cleveland, OH, USA.
PURPOSE: Tissue expansion is a powerful tool for the reconstruction of soft-tissue defects in pediatric patients. However, complications have been reported as high as 48% for cervicofacial pathology. Unique challenges include respecting the confluence of facial aesthetic units and avoiding ectropion. The senior author’s experience with pediatric cervicofacial tissue expander (TE) placement is presented with an aesthetic-unit based algorithm.
METHODS: A retrospective study of pediatric patients who underwent cervicofacial TE placement by the senior author was performed over a 16-year period (1/2006 to 2/2022). Predictor and outcome variables were included. Univariate and multivariate logistics regressions were performed on all variables. A p≤0.05 was considered statistically significant.
RESULTS: There were 111 TEs included with an 87.4% successful reconstruction rate. An aesthetic-unit based reconstructive algorithm is proposed based on the senior surgeon’s experience (Figure 1). Complications occurred in 21.6% of TEs and are detailed in Table 1. Iatrogenic ectropion was noted in 13.5% of patients; revisional surgery corrected 66.7% of cases. TEs that had at least one complication during expansion were significantly associated with the incidence of iatrogenic ectropion following flap advancement (O.R., 4.99; 95% C.I., 1.22-20.46; p=0.026).
CONCLUSION: By using an aesthetic-unit based algorithm, pediatric cervicofacial tissue expansion can be optimized.
| Outcome | Study population (N=111) |
| Length of follow-up (months), mean(±SD) | 27.5 (24.6) |
| Successful reconstruction, n(%) | 97 (87.4%) |
| Readmission, n(%) | 17 (15.3%) |
| Surgical site infection | 14 (12.6%) |
| Implant extrusion | 5 (4.5%) |
| Tissue expander deflated | 7 (6.3%) |
| Tissue expander replaced | 8 (7.2%) |
| Required antibiotic treatment | 14 (12.6%) |
| Premature explantation | 14 (12.6%) |
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