Despite its potential complications, tissue expansion in the pediatric population is an effective reconstructive modality. Because of the significant patient and family cooperation and effort needed in the expansion process, patients and families who are cooperative and compliant tend to have the best outcomes. Effective education and guidance, beginning preoperatively and continuing throughout the expansion process, are imperative. Although most of the reported complications may delay final reconstruction, few complications prevent the ultimate success of the reconstruction. For instance, expander rupture is treated by expander replacement, and expander exposure is treated by removal of the expander, advancement of the partially expanded flaps, and reinsertion of another expander once the flaps are healed. In both cases, the final reconstruction is delayed but not lost. Those surgeons who practice tissue expansion on a regular basis and are familiar with the best ways of handling complications as they arise will achieve optimal outcomes. The critical factors in achieving success are proper patient selection, thorough preoperative planning, parent and patient education, meticulous technique, and the ability to modify the reconstructive plan for each patient based on his or her clinical response.
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