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Great Ormond Street Hospital for Children NHS Trust UCL Institute of Child Health
 

Children and families

Tissue Expansion

This leaflet explains tissue expansion and what to expect when your child comes to Great Ormond Street Hospital. The team will make sure that you have enough information and are prepared for all stages of the treatment.

Contents

What is tissue expansion and why might my child need it?

Tissue expansion is a method of allowing the body to ‘grow’ more skin so that a plastic surgeon can use it to reconstruct a part of the body. It works by stretching the skin rather like pregnancy stretches a woman’s abdomen. A special bag is placed under the skin and gradually filled with fluid over a period of weeks or months. This ‘extra’ skin can then be used for repairing burns, scars and large birthmarks, for example, hairy naevi (moles). This method is particularly useful for hairy areas like the scalp, as the ‘extra’ skin is still able to grow hair. The new skin contains blood capillaries and the nerve endings needed for sensation. It is likely to be a good match for the colour and texture of the patient’s existing skin.

This method is suitable for almost all patients, but it may not be possible on areas that are already scarred as the skin is already weakened and may not stand up to stretching.

What is a tissue expander?

This is the piece of equipment used to ‘stretch’ the skin. It is a bag made of silicone, which comes in various shapes and sizes. A tube connected to the bag is used to fill it with fluid. As the bag fills with fluid, it stretches the skin over it. The fluid cannot escape from the bag as there is a valve between the bag and the tube. The tube can either be under the skin or part of it showing outside.

equipment used to ‘stretch’ the skin

What does the operation involve?

The operation to insert the tissue expander is carried out by a plastic surgeon (a doctor who specialises in reconstructive surgery). Your child will have a general anaesthetic for this operation, which lasts about one and a half hours.

Are there any risks?

There are few risks associated with using a tissue expander. There is a small risk of infection and bleeding following the operation to insert the tissue expander. Your child may be given an antibiotic injection during the operation to prevent any infection afterwards, and may continue to take antibiotics for a few days following surgery. Every anaesthetic carries a risk of complications, but this is very small. There is also a small risk that the wound will not heal properly after the operation.

The bag is a certain volume, but can often carry more fluid if needed, depending on the doctor’s advice. The amount of expansion required is carefully planned for each child. Every time the bag is filled, the amount of fluid inserted at each session and the overall amount of fluid that has been inserted so far is recorded carefully. It is possible that the bag may leak, but as the fluid inside is sterile saline (salt water), it does not cause any problems when absorbed by the body. If the bag leaks, your child will usually need to have it replaced in another short operation.

The main drawback with tissue expansion is that it is a time-consuming process. Also, depending on the age of your child, he or she may feel self-conscious about the tissue expander while it is in place, which is why good preparation and explanations are needed.

Are there any alternatives?

The main alternative is to use skin grafts, where layers of skin are removed from one part of the body to reconstruct another. This tends to be more painful as both the site of the operation and the site from where the skin was taken is sore. There is also an increased risk of scarring with skin grafts and sometimes grafts fail to ‘take’, which means another operation is needed. However, there are circumstances in which skin grafts are the only possible method of treatment.

Before the operation

You and your child will need to be assessed and prepared so that we can decide with you whether the procedure is suitable. The factors that are taken into account include your child’s age and level of understanding about the procedure. The process will involve the senior nursing staff, the ward play specialist and a clinical psychologist. During this assessment, we will show you a tissue expander and explain in more detail how it works. We may also show you photos of other children with a tissue expander in place.

You will receive information in your admission letter about how to prepare your child for the operation. You will need to come to the ward the day before the operation is due so that you can meet the team who will be looking after your child. The nurses will show you round the ward and ask you some questions. They will also tell you about your stay and how they will be involved in your child’s care before and after the operation. Your child will need to have a blood test to check that everything is fine before the operation, and a photograph may be taken of the area to be expanded. The doctors will also need to see you to explain the operation in more detail, discuss any worries you may have and ask you to sign a consent form. If your child has any medical problems, such as allergies, please tell the doctors. If your child is taking any medications, please bring these with you. An anaesthetist will also visit you to explain your child’s anaesthetic in more detail.

After the operation

Your child will return to the ward. He or she may have a small tube coming from the operation site. This is to drain away any excess blood and will be removed 24 to 48 hours after the operation, depending on how much is draining. Your child may also have a drip into a vein, to give fluids until he or she is drinking again. Your child will be able to leave hospital about two to three days later. Once you return home, the wound should be kept dry until the medical staff advise you otherwise. This will help it to heal properly.

Coming back in to hospital

Your child will need to come back to the hospital about 10 to 14 days after the operation to have the wound checked and the stitches removed if necessary (some stitches dissolve by themselves). We will tell you the date to come back before you leave hospital. If the wound has healed well, the team can begin to fill the bag with fluid. If possible, it will be filled at the same time each week, by the same nurse or doctor. If your child feels any pain while the bag is being filled, please tell the nurse or doctor immediately.

If your child’s tube is under the skin, your nurse will ask you to put a small amount of anaesthetic cream over the injection site approximately one hour before the appointment time. This will numb your child’s skin so that he or she does not feel any pain during the injection. Your child may feel uncomfortable while the bag is being filled with fluid but should not be in pain. The discomfort is usually worst during the first few hours after the fluid is inserted.

If you cannot attend an appointment, please ring the ward and speak to the nurse in charge as soon as possible so you can arrange another time which is convenient to you both. You will need to return to the hospital regularly over a period of weeks or months to get the best results, so it is vital that you do not miss an appointment without rearranging it.

When the bag contains enough fluid and the skin has stretched enough, your child will need to have another small operation to remove the tissue expander and carry out the reconstructive surgery.

When you get home

You should call the ward if:

  • the operation site is red and warmer than the surrounding skin

  • your child has a temperature of 37.5°C or more, and paracetamol does not bring it down

  • the area around the tissue expander is painful

Any of these symptoms may mean that your child has an infection and will need to come back to hospital for a check-up and antibiotics.

Do not apply any undue pressure to the area of the tissue expander. This includes prodding or poking it and wearing tight clothes over the area.

Your child will be able to return to school, and the ward staff can give his or her teachers specific information if they want it. If your child has any problems because the tissue expander attracts attention or provokes bullying, the ward staff or clinical psychologist can also give advice on this. As a general guide, we do not recommend that your child does PE or sport while the tissue expander is in place, just in case it gets damaged.

As the tissue expander is filled with more fluid, your child may have difficulties in finding a comfortable sleeping position. The ward staff can advise you on how to position your child so that he or she is comfortable. Your child may also need to start wearing looser clothing over the area of the tissue expander.

Ref: F010073 © GOSH Trust 2001
This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.

This page was last updated on 12 August, 2008