Complications of tissue expansion.

he previous articles in this issue have dealt in depth with the technique of tissue expansion and its unique and remarkable advantages for T soft tissue reconstruction. However, as with all aspects of cutaneous surgery, tissue expansion does have its share of disadvantages and potential complications (Table 1). The disadvantages of tissue expansion are relatively few. The procedure does require at least two operations and multiple visits to the physician are required during the 6 to 8 weeks of expansion. Up to 20 sterile injections may be required.' Some authors have advocated inflation in the home setting, but this is not typically recommended. Tissue expansion may necessitate time away from work or school dependent in part upon how well the patient tolerates the cosmetic deformity and body image distortion that occurs with the procedure. Indeed, patient selection is extremely important prior to undertaking tissue expansion. The patient needs to be well informed, motivated, mentally competent, and fully understand the nature of the procedure. Patients invariably will respond to the obvious distortion in body image in a number of ways with negative reactions ranging from depression, to withdrawal, to even exhibitionist behavior. Some patients may simply be unable to tolerate tissue expansion because of unacceptable body image distortion and/or psychologic instability. Children can be an additional challenge although most are able to continue with their normal activities, including school. Successful expansion in the pediatric population is widely reported. Complications of tissue expansion are more numerous and varied than are the simple disadvantages. Fortunately, most complications are minor and can be resolved without interruption of the expansion procedure. Reported rates of complications vary widely from 5 to 60%.2-5 The discrepancy of this rate is multifactorial, owing in part to the experience and expertise of the surgeon, the anatomic site of the expanded tissue, the health