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At UPMC Children's Hospital of Pittsburgh, we believe parents and guardians can contribute to the success of this surgery and invite you to participate. Please read the following information to learn about the surgery and how you can help.
Tissue expansion is a fairly simple way for doctors to create extra skin that can be used to replace or repair skin on other parts of the body. Similar to the way a pregnant woman’s skin stretches as the baby grows inside her, tissue expansion uses a balloon called an expander to stretch the skin covering it. Over a period of several weeks, the expander is filled with liquid to gradually stretch the skin around it. When enough extra skin has been created, the tissue expansion is complete and the next step in the reconstruction can be scheduled.
Expanded tissue may be used to repair skin that has been injured, burned, scarred from a previous surgery or prior to a surgery to remove large birthmarks and congenital nevi (con-GEN-it-ool NEE-vie) or hairy brown moles. It is particularly ideal for scalp repair because the stretched skin on the scalp retains normal hair growth. Most other body tissue does not grow hair to the same degree as the scalp, so tissue expansion of the scalp gives a much better appearance after the reconstruction.
Tissue expansion can be done practically anywhere on the body, and your child’s doctor will determine the best area for the expander balloon to be placed. Some common areas for tissue expansion are in the thigh, back, abdomen and scalp. Usually, the expander is placed near the site of the skin being replaced so that a flap of skin can be created. When the damaged skin is removed, the flap of extra skin is pulled into place.
Once the expander has been healed in place under your child’s skin, it will be filled with about 20 mLs (a little more than 1/2 an ounce) of sterile saline (SAY-leen) each week during the tissue expansion process. Sometimes more or less saline is used depending on the size of the expander. Saline is a liquid that is present in the body and is similar to tears, so it is completely safe to use inside the body.
Just below the surface of the skin where the expander is placed there will be a small button called a “port.” This port is connected to a tube attached to the expander and acts as a plug to keep the saline in, while allowing more saline to be added when needed. Each time your child needs to have saline added to the balloon, a special cream will be rubbed on the skin right over the port to numb it so your child will feel no pain. After about an hour, when the skin over the port is numb, a thin needle will be inserted into the center of the port to add the saline. The saline inside the balloon has some blue dye in it, so before the saline is put in, a small amount of liquid will be pulled out through the syringe (seer-RINJ) or needle to make sure the needle is in the right spot. If blue liquid is seen, the needle is in the expander and new saline will be added.
Your child may feel a bit uncomfortable just after the saline has been added to the expander, and the skin around the expander may feel taut or tight to the touch. Within a few hours, your child’s discomfort will go away, and in the days after the saline is added, the skin will stretch and feel soft again.
Expanders come in several sizes, but most expanders hold about 200 mLs of liquid, or about the same amount as in a typical juice box. If more tissue is needed, your child’s doctor may choose to use a larger tissue expander, which will create a larger bulge in the skin. Sometimes, several tissue expansions are needed to create the amount of skin needed. Your doctor will determine if a larger expander or more than one expander is needed.
When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. One business day before your child’s surgery, you will receive a phone call from a nurse between the hours of 1 and 9 p.m. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions.
For children older than 12 months:
For infants under 12 months:
For all children:
Your child’s tissue expander placement surgery will be done through the Same Day Surgery Center at Children’s Hospital in Lawrenceville. When you have checked in at the Same Day Surgery Center, you and your child will be called to an examination room where your child’s health history will be taken and vital signs will be checked.
You will meet with one of the doctors on your child’s surgical team to go over the surgery. He or she will answer any last-minute questions you might have at this time. A member of the anesthesia staff also will meet with you and your child to review his or her medical information and decide which kind of sleep medication he or she should get. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.
When it is time for your child to go the operating room, you will be asked to wait in the surgical family waiting area.
The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm.
During the surgery, at least one parent or guardian should remain in the surgical family waiting area at all times, in case the family needs to be reached.
While your child is asleep, his or her heart rate, blood pressure, temperature and blood oxygen level will be checked continuously. To keep your child asleep during the surgery, he or she may be given anesthetic medication by mask, through the IV or both. When the surgery is over, the medications will be stopped and your child will begin to wake up.
When your child is moved to the recovery room, you will be called so that you can be there as he or she wakes up.
A complete list of instructions for taking care of your child at home will be given to you before you leave the hospital. The main things to remember are:
Division of Pediatric Plastic Surgery
UPMC Children's Hospital of Pittsburgh
One Children’s Hospital Drive
4401 Penn Ave.
Pittsburgh, PA 15224
Children's Hospital's main campus is located in the Lawrenceville neighborhood. Our main hospital address is:
UPMC Children’s Hospital of Pittsburgh
One Children’s Hospital Way
4401 Penn Ave.
Pittsburgh, PA 15224
In addition to the main hospital, Children's has many convenient locations in other neighborhoods throughout the greater Pittsburgh region.
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