[Indications of the expansion in pediatric surgery. Experience of 30years and literature review]. / Indications de l'expansion chez l'enfant. Expérience de 30ans d'activité et revue de la littérature.

ABSTRACT

The expansion of soft tissue, especially skin, is an old and physiological process to increase the skin reserve allowing excision while coveraging of the resulting loss of substance. Easy in principle, this process is subjected to constraints in children requiring precise planning and rigorous technical procedure. Between 1990 and 2016, we performed 293 expansion protocols with 411 implants in 244 children. The scalp was the most interested area (158 cases), followed by the trunk (29). The congenital nevi represented the most frequent indication (119 cases), followed by sequelae of burns and scars (64 cases) and hamartoma sebaceous of Jadassohn (27 cases). Three categories of indication can be established. Ideal indications of the expansion are on the scalp, skin preparation prior to the excision of a large nevus, nevus sebaceous of Jadhasson and severe breast hypoplasia. Common but delicate indications are scars, especially after burns, treatment of vertex aplasia cutis congenita and expansions of the limbs, abdomen, head and neck. Rare indications include separation of Siamese twins, or protection of the bowel before radiotherapy. Contra-indications are infected lesions, malignant tumors and lesions requiring immediate coverage. If the principle of expansion is relatively simple, its positioning on the scale of reconstruction methods is harder because of the risk of significant complications.