Lower Extremity Tissue Expansion in Pediatric Patients
Cynthia Yusuf1, Christopher Lopez2, Kimberly Khoo2, Alisa Girard2, Isabel Lake2, Howard Yang2, Robin Yang2, Richard Redett2,
1 University of Maryland School of Medicine, Baltimore, MD2 Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
Background: Tissue expansion remains the approach for soft-tissue reconstruction in pediatric patients. It is well known that tissue expander placement in the lower extremity is associated with high rates of complications including infection and extrusion, leading to premature expander removal and delays in reconstruction. The aim of this study was to further categorize risk factors within lower extremity tissue expander placement in the pediatric population.
Methods: A retrospective study of pediatric patients who underwent tissue expander placement in the lower extremity by the senior author (R.J.R) was performed over a 16-year period. Patient charts were reviewed to categorize baseline characteristics to include race, sex, age at surgery, residential distance from the institution, median household income (MHI), immigration status, parent status of the household, number of siblings, insurance coverage, and number of prior expanders at the operative site. Patient charts were then reviewed for operative characteristics to include surgical indication, time to surgery from first hospital visit, time to surgery from first plastic surgery visit, number of expanders placed at a single operation, expander size, and post-operative antibiotic usage. Primary outcome variables were surgical-site infection (SSI), expander extrusion, and premature explantation.Secondarily, any potential associations between patient baseline characteristics and operative characteristics were investigated. Univariate and multivariate logistic regressions were performed, as well as student t-tests (alpha <0.05).
Results: A total of n = 59 tissue expanders were placed in the lower extremity of n = 16 pediatric patients. Total complication rates were 23.7%: 16.9% (n= 10/59) for SSI, 11.9% (n=7/59) for expander extrusion, and 20.3% (n=12/59) for premature explantation. Antibiotic prophylaxis was significantly associated with an increased risk of expander extrusion (OR, 12.8; 95% CI, 1.75 to 156.97; p<0.005) and premature explantation (OR, 61.76; 95% CI, 8.60 to 823.21; p<0.0001). However, type of antibiotic used had no significant association with SSI, expander extrusion, or premature explantation. It was also found that children who live in a single-parent household have, on average, 2.6 more days to surgery from their first plastic surgery provider visit compared to those who live in a two-parent household (p< 0.01).
Conclusion: Stratification of complications in lower extremity tissue expanders in pediatric patients remains poorly described. This is the first study to date that describes complications in terms of SSI, expander extrusion, and premature explantation following placement of lower extremity expanders in the pediatric population. Notably, prophylactic antibiotic administration is associated with an increased risk of expander extrusion and premature explantation.
Back to 2022 Abstracts