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Tissue Expansion In The Pediatric Patient: A 23-Year Single-Institution Experience
Isabel A. Ryan, BS, Mattia A. Mahmoud, MPhil, Philip D. Tolley, MD, Nicholas A. Han, BSE, Allison C. Hu, MD, Cassandra A. Ligh, MD, David W. Low, MD, Oksana A. Jackson, MD, Scott P. Bartlett, MD, Jordan W. Swanson, MD, Jesse A. Taylor, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
PURPOSE: Given the dearth of literature on pediatric tissue expander (TE) indications and risk, we aim to characterize its use at our institution over the past 23 years, focusing on post-operative outcomes stratified by location, indication, and repeat expansion.
METHODS: A retrospective review of all patients who underwent TE placement from 2001-2024 was conducted. Demographic, operative, and outcomes data was collected and compared using descriptive statistics and multivariable logistic regression.
RESULTS: 210 patients with a total of 510 TE were included. The most common diagnoses were congenital nevus (22%, n=46), scarring (19%, n=40), and omphalocele (12%, n=26). Successful reconstruction was achieved in 93% of patients (n=196). 21% (n=43) underwent repeat expansion of the same anatomic location. Complications occurred in 21% (n=108) of expanders and 14% (n=73) required premature explantation. On multivariable analysis, use in conjoined twins (47%, OR 5.2, p<0.001), use for wound reconstruction (75%, OR 14.9, p=0.004), and repeat expansion (29%, OR 1.7, p=0.03) were associated with increased odds of complications. Expander placement at less than 4 years was associated with increased odds of premature explantation (20%, OR 2.0, p=0.03) controlling for conjoined twin diagnosis and TE stage, number, and size (cm2).
CONCLUSION: Pediatric tissue expansion allows for effective soft tissue reconstruction in a multitude of anatomic locations and conditions, but remains daunting for families and is not without risk. Repeat expansion, use in conjoined twins, and use for wound reconstruction are predictive of increased complications. Placement at less than 4 years may increase the odds of premature explantation.
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