Tissue expander complications in the pediatric burn patient.

Tissue expanders have become a useful adjuvant in pediatric burn reconstruction. We reviewed our experience with tissue expanders from June of 1984 to July of 1995. There were 403 expanders used in 301 patients. Complications relative to specific anatomic areas from July of 1987 to July of 1995 were compared with previously published data in the journal from June of 1984 to June of 1987. Complications were defined as absolute if they resulted in the loss of expanders or in additional surgery, or none of the preoperative plan was satisfied. The relative complications were defined as spotty alopecia, alopecia greater than 50 percent, or the operative plan was only partially satisfied, sometimes implying poor surgical judgment. The overall complication rate for the period June of 1984 to June of 1987 was 30 percent (37 complications in 122 expanders). In the July of 1987 to July of 1995 study, the complication rate was only 18 percent (51 complications in 281 expanders). This was a statistically significant decrease between the periods (p = 0.010). In the recent 8-year period, there was a decrease compared with the previous study in both the absolute and relative complications. The most common absolute complication in this period was infection (15 of 31, 48 percent) with 12 (39 percent) being early infection. With regard to the nine complications in the neck, face, ear, and supraclavicular area, two-thirds were related to leakage or exposure of the expanders, resulting from the tight anatomic area causing mechanical damage of the expanders as well as ischemia to the overlying skin. Early in the study, the lower extremities proved to involve difficult or unsatisfactory areas to expand, and lower extremity expansion was abandoned throughout the remainder of the study period. The overall decrease in absolute and relative complications is likely the result of increased operative experience as well as a developed protocol for the prevention of perioperative complications relating to infection and expansion in high-risk anatomic sites.

The management of perineal contractures in children with burns.

A retrospective review of patients undergoing reconstruction for perineal scar contracture between 1980 and 1991 was performed to determine the surgical principles involved in perineal contracture release. Of the 5280 reconstructive admissions, 18 (0.34%) were for perineal contracture release. Fifty-six percent of patients received a local flap as an initial release, 28% underwent incisional release with split-thickness skin grafting (STSG), 5% had primary release and closure, and 11% had a combination of these techniques. Recurrences developed in 40% of the local flap group, 20% of the STSG group, and 50% of the combination group, with no statistical differences between groups. Although there was a higher rate of recurrence in the flap group, the procedure was much simpler to perform and recovery time was shorter. The use of STSG should be reserved for large bilateral contractures and recurrences, especially if normal skin for a flap is not available. Growth is an important variable in the development of perineal contractures in children with burns; thus these patients should be followed up closely during rapid-growth periods.