L’expansion cutanée chez l’enfant : indications et gestion des complications. Notre expérience sur 10 ans

Abstract

Tissue expansion is a plastic surgery technique which enables optimal quality and skin surface reconstruction in case of soft tissue defect. Despite the good results obtained, both from a functional and aesthetic point of view, there is a high rate of complications whose management seems to be essential to ensure satisfactory results. We retrospectively reviewed the medical files of 45children treated in our department between 2002and 2012: 73expanders were placed during 51protocols. The studied protocols gathered a large variety of situations. Varied pathologies were treated: burn sequelae (39%), giant congenital naevus (GCN) (27%), scars (20%), hamartoms (8%), cutis aplasia (6%), as well as diverse sites: scalp (45%), trunk (35%), head and neck (8%), lower extremity (8%), upper extremity (4%). Complications occurred in 17protocols representing 26% of total expanders. GCN is a pathology with a significantly lower complication rate (P=0.013) whereas trunk is an anatomical location with a significantly higher complication rate (P=0.026). Overall, 84% of reconstructions were evaluated as having a good result. This rate reached 76% for complicated protocols. Tissue expansion in paediatric patients remains an efficient therapy in order to achieve a satisfactory reconstruction. Despite a high complication rate, good results can be obtained even in those complicated cases as long as they are well managed and anticipated. We also think that specific paediatric material would help to reduce supervention of some complications.