Endoscopic Approach for Tissue Expansion for Different Cosmetic Lesions in Pediatric Age

Abstract

Background/Purpose: The use of tissue expanders in plastic and reconstruction surgery is now well established for large defects in adults & children. Tissue expansion is one of the reconstructive surgeon's alternatives in providing optimal tissue replacement when skin shortage is a major problem. Predesigned plan about the criteria of tissue expansion should be implied before embarking on removal of a lesion. Endoscopic placement of tissue expanders has the benefit of reducing operative time, major complication rate, time to full expansion and length of hospital stay compared to the open technique for tissue expander placement. Materials & Methods: The study was carried on 15 cases for which 22 expanders were inserted .All cases were in the pediatric age (6-15 years) .Nine cases had melanocytic pigmented naevi, four cases had post-burn scars, one had pigmented lymphangiomatous lesion & the last case had post grafting scarring .Eight patients needed single insertion of the expander followed by definitive reconstruction (2 months later), 4 cases needed multiple expanders on the same session & 3cases needed sequential expansion. The process of expander placement was done through a remote incision using endoscopic approach, after the required inflation (usually 2 months) reconstructive surgery was carried on for flap designing. Results: Twenty two expanders were inserted in 15 cases .operating time ranged from 50-70 min. (mean= 1 hour) in early cases .Later on the time was shortened to a mean of 40 ± 5 min. The mean duration for completion of expansion to the required dimensions needed for the flap was 2 months ( + 2 weeks ) . Complication rate was 18%. They occurred in 4 out of 22 expanders (hematoma ,wound dehiscence and seroma around 2 expanders). Conclusion: Tissue expansion in the pediatric population has its implication in different plastic problems. Endoscopic assisted expansion is a new trend in expander placement that has its role in decreasing complications related to insertion of expanders. Index Word: Tissue expansion- Endoscopic- Pediatric.