Pediatric Tissue Expansion: Techniques, Considerations, and Complications | Journal CME Article-Journal CME Article: Pediatric Tissue Expansion: Techniques, Considerations, and Complications

Journal CME Article: Pediatric Tissue Expansion: Techniques, Considerations, and Complications

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This article provides a comprehensive review of pediatric tissue expansion (TE), a reconstructive technique used to generate additional skin and soft tissue through controlled mechanical strain for repairing congenital anomalies and other defects. First described in 1957, TE is notably applied in children for conditions such as congenital melanocytic nevi, burn scars, neck contractures, and various congenital deformities. It offers advantages like tissue matching in color and texture, reduced donor-site morbidity, and preserved sensation.<br /><br />Physiologically, TE induces gene expression changes mediated by mechanotransduction, involving hypoxia-inducible factor-1α pathways that promote neovascularization and tissue growth. Histologically, expanded skin thickens epidermally, thins dermally, and exhibits subcutaneous fat and muscle atrophy, with changes normalizing after expansion.<br /><br />Surgical considerations emphasize early childhood intervention to reduce psychosocial impact despite higher complication risks in children under seven years. Expander choice depends on defect size and location, with cylindrical, ovoid, or rectangular shapes tailored to the site. Both internal and external ports are used; external ports enable at-home inflation but carry higher complication risks, while internal ports require skilled access. Surgical technique involves submuscular or subgaleal pocket creation, cautious incisions smaller than the expander, and strategic expander positioning especially in the head and neck. Expansion typically begins two weeks post-placement, with weekly fills guided by tissue response and patient comfort.<br /><br />Region-specific approaches are outlined: head and neck reconstruction requires preserving vital structures and may use contralateral or bilateral expanders; lower extremity expansion faces higher complication rates due to poorer vascularity and is preferably done in the anterior thigh.<br /><br />Common complications include infection (up to 10%), hematoma, expander exposure or rupture, with risk factors being multiple expanders, large volumes, or specific anatomical sites. Early identification and management of complications, including potential expander removal and delayed re-expansion, are critical. Overinflation is a clinically accepted practice to account for tissue contraction without increasing complications.<br /><br />In conclusion, pediatric TE remains a valuable technique with evolving strategies to optimize outcomes and manage complications. Continued research into pediatric-specific tissue responses aims to refine protocols, enhancing safety and reconstructive success for children with complex soft-tissue defects.

Keywords

pediatric tissue expansion

reconstructive technique

congenital anomalies

mechanotransduction

hypoxia-inducible factor-1α

neovascularization

surgical considerations

expander types

complications

head and neck reconstruction