Plastic Surgery Research Council

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Pediatric Tissue Expansion: Predictors of Premature Expander Removal in A Single Surgeon's Experience with 472 Expanders
Howard D. Wang, MD1, Zuhaib Ibrahim, MD2, Amy Quan, MD, MPH1, Jennifer Bai, MD3, Benjamin T. Ostrander, MS1, Richard J. Redett, MD1.
1Johns Hopkins Hospital / University of Maryland, Baltimore, MD, USA, 2Institute for advanced reconstruction, Shrewsbury, NJ, USA, 3Northwestern Memorial Hospital, Chicago, IL, USA.

PURPOSE: Tissue expansion is an important technique for soft tissue reconstruction in pediatric patients. However, the expansion process is associated with significant complications that may necessitate expander removal and result in reconstructive delays. The aim of this study was to identify the risk factors associated with premature expander removal due to infection or extrusion in pediatric patients.
METHODS: 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 including age, sex, race, indication, the anatomic location, the number of expanders inserted, serial expansion, and expander size were collected. Bivariate and multivariate analyses were performed to identify risk factors for premature expander removal.
RESULTS: 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 (OR 0.91, CI 0.83-0.98, P=0.01), greater number of expanders (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.
CONCLUSION: Infection or extrusion leading to expander removal occurred in approximately 10% of expanders. The odds of premature removal are increased with younger age, greater number of expanders placed, and lower extremity location.


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