Soft Tissue Expansion in Children

There is nothing fun about being different – especially for children.  Soft tissue expansion is widely used for reconstruction surgery in children and has greatly modified the treatment of many congenital anomalies.  In addition to providing expanded skin grafts to cover large defects, this technique improves cosmetic results by providing tissue with matching characteristics and color.  In most patients, donor tissue is expanded from adjacent areas.  It is important for the family to understand that this is a long procedure that requires both hospitalization (for placement and reconstruction) and weekly visits (for filling).  The child and family should be prepared to wait as long as necessary to achieve the desired results and not plan on specific dates to complete the procedure.  Fortunately for most, this process is viewed as a step toward eliminating their disabilities or as a means of restoration.

Like all candidates for skin expansion, children must undergo a thorough examination to note the size and shape of the lesion, the condition of skin, the area available for expansion, and the presence of risk factors such as flexion folds, scars, chronic wounds, and infection.  If necessary, the surgeon can use a template to simulate the prosthesis and draw a sketch to show the position of the expanders, valves, and placement incisions.  At the end of the examination, the surgeon should be able to estimate the final dividend of expanded skin and determine whether the lesion can be completely excised in a single course as well as where the residual scars will be.

Basically, a rubber balloon (expandable implant) is placed beneath the skin and gradually filled with saline solution over a period of time.  This process is similar to what happens to the abdominal area during pregnancy.

Some Indications

Head and Neck

Lesions on the head and neck are frequent indications for skin expansion in children.  These include alopecia, the benign tumors, scars, and reconstruction.

Alopecia

Alopecia can be congenital or acquired.  This distinction is important because greater precaution is necessary for acquired alopecia because the skin is usually damaged.  This is especially true for burn related lesions, which require strictly sterile conditions and expander placement under healthy skin.

Benign Tumors

The most common benign tumors of the head and neck are the nevi.  Removal is necessary for cosmetic reasons but in some cases excision is also needed to prevent malignant transformation.  For example, Jadassohn nevi frequently degenerated to basal cell epithelioma in adulthood.  Before the advent of tissue expansion, a large full thickness skin graft was often required to replace nevi from the face.

Scars

Tissue expansion greatly facilitates scar excision.  As previously noted, strict attention to sterility is necessary when dealing with burn related scars.  To avoid recurrence due to wound compression, a neck brace should be worn during the postoperative period.