Tissue expansion in the extremities using external reservoirs.

Over a 24-month period, 18 patients had 33 expanders placed in the extremities. Twelve expansions were performed in the upper extremity, and 21 in the lower extremity. Indications for expansion include scarring, excision of skin grafts, tumor excision, burn scars, tattoos, or unacceptable incisional scars for revision. Of the 12 expansions performed in the upper extremity in seven patients, nine were successful. Nine expansions in the thigh and two expansions in the region of the knee were completed without complication. Three expansions were performed in the distal lower extremity following crush injury to remove scarring, and all three failed. Seven expansions were performed in the foot for removal of scarred tissue. There was one infection, two skin necroses on the dorsum of the foot, and one implant exposure. Seven complications in the lower extremity occurred in these areas with an infection rate of 20%. The remaining 23 expansions were performed for soft tissue defects in the upper extremity or in the lower extremity above the level of the mid-calf, with only two complications of implant exposure or infection. Therefore, the infection rate and complication rate in the upper extremity and above the knee was only 6%. Overall, 23 of the 33 expansions, or 70%, were taken to completion with a successful advancement of expanded flaps. Overall, complications occurred in 30% of patients, all eventually requiring removal of the expander.(ABSTRACT TRUNCATED AT 250 WORDS)