Skin Expansion Long Term Follow Up of Complications and Costs of Care

Abstract

To find out our rate of complications after tissue expansion, and the cost of treatment in terms of use of hospital resources and length of sick leave, we analysed our experience of 181 expansion treatments in 97 patients undertaken between 1986 and 1991. There were 60 women and 37 men, with a mean age of 22 (range 1–74). Twenty patients had more than one period of treatment (range 2–8). The most common conditions treated were naevi (n=15); scars (trauma - n=33, burns - n=17, and operations - n=16); and breasts that required reconstruction (n=15). Of the 181 expansions there were 29 failures (16%), and 117 complete successes (64%); fifteen of the latter developed minor complications (8%), 35 were partly successful (20%). There were 77 complications in 71 treatments (38%), and 45 expanders (25%) had to be removed prematurely because of complications. The most common complications were skin penetration (n=15), minor infection (n=13), and breakdown of the surgical wound (n=13). The median (range) inpatient hospital stay was 8 days (2-39); number of visits to the outpatient clinic for filling 7 days (0-20); and total treatment time/patient 82 (19-286). We conclude that skin expansion is a useful technique, but that there is room for improvement in reducing the rate of complications and the amount of time that patients spend being treated.

Key Words:

• tissue expansion
• skin flap
• reconstruction