title: Utility of tissue expansion in pediatric phallic reconstruction: a 10-year experience.
abstract: OBJECTIVE
  Boys with complex penile anomalies often undergo multiple operations, leaving a paucity of unscarred skin for further reconstructive procedures. Our objective was to evaluate the ability of tissue expansion to provide local skin for successful phallic reconstruction.
  
  
  METHODS
  Eighty boys (mean age of 11.9 years) with hypospadias (n = 42) or epispadias (n = 38) formed the study cohort. All patients had undergone at least one failed reconstructive operation. Indications for tissue expansion included scarcity of penile skin with urethral stenosis, urethrocutaneous fistula, chordee, and/or residual defect. One or two expanders were placed under the skin of the penile shaft and removed at the time of reconstruction.
  
  
  RESULTS
  Average time between expander placement and reconstruction was 10.9 weeks. Mean follow-up time was 25.3 months. Complications during expansion occurred in 33 patients (41.3%). Twenty-two patients (27.5%) had at least one expander removed prematurely and 46.9% were replaced. Expansion yielded adequate tissue for reconstruction in 76 patients (95.0%). Successful outcomes were achieved in 39 patients after initial reconstruction and 25 patients after further intervention, yielding an overall success rate of 80.0%.
  
  
  CONCLUSIONS
  Tissue expansion is a useful tool with an acceptable rate of complications for phallic reconstruction in patients who have failed prior surgical reconstruction.
authors: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, JHOC 8, 601 North Caroline Street, Baltimore, MD 21287, USA. Electronic address: danielle.rochlin@jhmi.edu.
authors: D H
authors: DH
authors: Rochlin
authors: Department of Radiology, State University of New York Downstate Medical Center, 450 Clarkson Avenue #24, Brooklyn, NY 11203, USA. Electronic address: karl@jhmi.edu.
authors: K
authors: K
authors: Zhang
authors: Department of Urology, Johns Hopkins University School of Medicine, 1800 Orleans Street #7304, Baltimore, MD 21287, USA. Electronic address: jgearhart@jhmi.edu.
authors: J P
authors: JP
authors: Gearhart
authors: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, JHOC 8, 601 North Caroline Street, Baltimore, MD 21287, USA. Electronic address: arad1@jhmi.edu.
authors: A
authors: A
authors: Rad
authors: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, JHOC 8, 601 North Caroline Street, Baltimore, MD 21287, USA. Electronic address: jkelami1@jhmi.edu.
authors: A
authors: A
authors: Kelamis
authors: Department of Urology, Johns Hopkins University School of Medicine, 1800 Orleans Street #7304, Baltimore, MD 21287, USA. Electronic address: rmathews@jhmi.edu.
authors: R
authors: R
authors: Mathews
authors: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, JHOC 8, 601 North Caroline Street, Baltimore, MD 21287, USA. Electronic address: rredett@jhmi.edu.
authors: R J
authors: RJ
authors: Redett
mesh_terms: D002648:Child; D004842:Epispadias / Q000601:surgery*; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D010413:Penis / Q000002:abnormalities / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D015626:Tissue Expansion; D015625:Tissue Expansion Devices; D014521:Urethra / Q000601:surgery*
keywords: Epispadias; Hypospadias; Penile deformity; Tissue expander