Cervicofacial Pediatric Tissue Expansion: Aesthetic Unit–Based Algorithm

Background: Tissue expansion is a powerful tool in reconstruction of pediatric soft-tissue pathologies, but complication rates in children have been reported to be as high as 40%. Infection and implant extrusion lead to premature removal and delays in reconstruction. Expanding the head and neck is uniquely challenging because the confluence of facial aesthetic units must be respected. These challenges prompted the senior author (R.J.R.) to create an aesthetic unit–based algorithm. Methods: A retrospective study of pediatric patients who underwent cervicofacial tissue expander placement over a 17-year period was performed by the senior author. Predictor variables included age, sex, race, indication, number of expanders placed at each operation, serial expansion, expander type, expander size, home versus clinic inflation, and prophylactic antibiotics. Univariate and multivariate analyses were performed to identify risk factors for complications. Results: An aesthetic unit–based reconstructive algorithm is proposed. Forty-eight pediatric patients had 111 cervicofacial tissue expanders placed. Twenty expanders were associated with complications (18%) for surgical site infection (12.6%), extrusion (4.5%), or expander deflation (6.3%). Expanders placed for congenital nevi ( P = 0.042) and use of textured expanders ( P = 0.027) were significantly associated with decreased complication levels. When controlling for covariates, serial expansion of the same site was associated with increased rate of readmission ( P = 0.027) after having just 1 previous expander. Iatrogenic ectropion occurred in 13.5% of the study population; expanders with at least 1 complication during tissue expansion were significantly associated with incidence of iatrogenic ectropion ( P = 0.026). Conclusion: By using an aesthetic unit–based algorithm, reconstructive outcomes can be optimized for pediatric cervicofacial tissue expansion. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.