Osmotic expanders in children: No filling – no control – no problem?

Abstract

Background: Self-filling, hydrogel-based osmotic tissue expanders have been successfully used for several years, mainly in adult patients. We wanted to test this novel device in pediatric plastic and reconstructive surgery.

Material and Methods: Between November 2004 and September 2009, we implanted 53 osmotic tissue expanders following standard surgical principles in a total of 30 children and adolescents with burn scars, congenital nevi, alopecia, or foot deformities.

Results: All expanders reached their predicted volume within 6 weeks and 51 (96.2%) produced a sufficient amount of additional skin for the intended coverage of the defect. A serious infection precluding the planned reconstructive procedure occurred with 2 expanders (3.8%). Minor complications occurred at 6 implantation sites (11.4%), and consisted of small necrotic areas and perforations (n=3) and minor infections (n=3). These problems could be controlled and did not interfere with the subsequent plasty. The final results recorded at the last follow-up (mean: 21 months, range: 9–48 months) were rated as excellent in 25, good in 19, moderate in 6, and poor in 1 patient.

Conclusion: This is apparently the largest pediatric series in which self-filling expanders have been used. The data obtained indicates that self-filling expanders can be safely and effectively used for various plastic, reconstructive and orthopedic procedures in children and adolescents. The fact that numerous painful and distressing filling sessions are obviated with these expanders is particularly beneficial for those children too young to understand and cooperate. Moreover, this approach minimizes the risk of infection and lowers costs.

Key words

osmotic tissue expander - children - reconstructive surgery - scars - congenital nevus

References

• 1 Bennett RG, Hirt M. A history of tissue expansion. Concepts, controversies, and complications.  J Dermatol Surg Oncol. 1993;  19 1066-1073
• 2 Bauer BS, Corcoran J. Treatment of large and giant nevi.  Clin Plast Surg. 2005;  32 11-18
• 3 LoGuidice J, Gosain AK. Pediatric tissue expansion: indications and complications.  J Craniofac Surg. 2003;  14 866-872
• 4 Friedman RM, Ingram Jr AE, Rohrich RJ. et al . Risk factors for complications in pediatric tissue expansion.  Plast Reconstr Surg. 1996;  98 1242-1246
• 5 Rivera R, LoGiudice J, Gosain AK. Tissue expansion in pediatric patients.  Clin Plast Surg. 2005;  32 35-44
• 6 Wiese KG. Osmotically induced tissue expansion with hydrogels: a new dimension in tissue expansion? A preliminary report.  J Craniomaxillofac Surg. 1993;  21 309-313
• 7 Wiese KG, Heinemann DE, Ostermeier D. et al . Biomaterial properties and biocompatibility in cell culture of a novel self-inflating hydrogel tissue expander.  J Biomed Mater Res. 2001;  54 179-188
• 8 Ronert MA, Hofheinz H, Olbrisch RR. The beginning of a new era: self-filling tissue expander for defect coverage in a 3-year-old boy with a retroauricular nevus.  Plast Reconstr Surg. 2003;  112 189-191
• 9 Sasaki GH. Tissue expanders and general guidelines for tissue expansion technique.. In:Tissue Expansion in Reconstructive and Aesthetic Surgery. St. Louis: Mosby; 1998: 8-23
• 10 Elias DL, Baird WL, Zubowicz VN. Applications and complications of tissue expansion in pediatric patients.  J Pediatr Surg. 1991;  26 15-21
• 11 Pisarski GP, Mertens D, Warden GD. et al . Tissue expander complications in the pediatric burn patient.  Plast Reconstr Surg. 1998;  102 1008-1012
• 12 Chummun S, Addison P, Stewart KJ. The osmotic tissue expander: A 5-year experience.  J Plast Reconstr Aesthet Surg. 2010;  [Epub ahead of print]
• 13 Obdeijn MC, Nicolai JP, Werker PM. The osmotic tissue expander: a three-year clinical experience.  J Plast Reconstr Aesthet Surg. 2009;  62 1219-1222
• 14 Ronert MA, Hofheinz H, Manassa E. et al . The beginning of a new era in tissue expansion: self-filling osmotic tissue expander – four-year clinical experience.  Plast Reconstr Surg. 2004;  114 1025-1031

Correspondence