Is soft tissue expansion in lower limb reconstruction a legitimate option?

From 1986 to 1994, a consecutive series of 34 patients had 37 expanders placed in their legs. Indications for expansion included removal of painful ro unstable scars, chronic post-traumatic ulcers and one benign skin lesion. In 13 patients the lesion or scar was greater than 5 cm in diameter. The area of expansion was mainly in the proximal and distal thirds of the lower limb. On three occasions two expanders were simultaneously used in the same patient. The treatment with this technique was ultimately successful in 23 patients (67.6%) but 15 of the 23 patients (44% of the 34 patients) had minor wound healing problems. Before 1990, technical complications such as leaking injection ports caused further small interventions in 6 patients without compromising the ultimate outcome. The goal was not achieved with the expansion technique in 11 patients (32%). 5 of these 11 patients could be treated successfully with another surgical modality. All 34 patients were re-evaluated with an average follow-up of 4.5 years. We conclude that tissue expansion is ideal for removal of localised areas of scar, repair of contour defects and excision of benign tumours. Contraindications of soft tissue expansion are, in general, extensive scarred areas with compromised blood supply after trauma, vascular disease and osteomyelitis. These conditions require reconstruction with well vascularised tissue such as muscle flaps. A compliant patient is essential for lower limb reconstruction with tissue expansion. In spite of the tempting simple method of tissue expansion, success in the lower limb depends not only on the indication but also on the operating technique of the plastic surgeon.