title: Ectropion in Facial Tissue Expansion in the Pediatric Population: Incidence, Risk Factors, and Treatment Options.
abstract: BACKGROUND
  Despite advances in the field of tissue expansion, the face is especially difficult to reconstruct using this technique due to its dynamic nature and high incidence of distortional scarring. This article aimed to review complications seen in pediatric facial tissue expansion, specifically ectropion, as well as its restorative treatment.
  
  
  METHODS
  A retrospective chart review of pediatric patients treated by tissue expansion for congenital facial lesions, trauma, or burns at Children's Hospital Los Angeles from January 2000 to present was performed. Patients were analyzed for preoperative diagnosis, reconstruction area, tissue expander location, number and fill volume of expanders, incidence of complications, including ectropion, and type of revision surgery.
  
  
  RESULTS
  A total of 88 patients with 150 expander reconstructions were examined. The total complication rate was 43.1% with an 11.3% rate of ectropion. Of the 10 cases of ectropion, 9 were treated with canthoplasty, whereas 1 was managed conservatively. In addition to canthoplasty, full-thickness skin graft was preformed in 1 patient, Z-plasty in 1, and lid switch in 2.
  
  
  CONCLUSIONS
  Tissue expansion is a safe and effective method of reconstruction for facial defects in the pediatric population despite complication rates being higher than other areas of the body. Specifically, ectropion can be a devastating complication, often requiring surgical correction. As such, careful planning should go into orientation and design of the reconstruction, and staged procedures should be strongly considered. Additionally, and possibly the most important, is setting patient and parental expectation about the possibility of ectropion and the necessity often for multiple corrective surgeries.
authors.affiliation: From the *Division of Plastic Surgery, Keck School of Medicine of the University of Southern California; and †Children's Healthcare Los Angeles, Los Angeles, CA.
authors.forename: Meghan C
authors.initials: MC
authors.lastname: McCullough
authors.forename: Margaret
authors.initials: M
authors.lastname: Roubard
authors.forename: Erik
authors.initials: E
authors.lastname: Wolfswinkel
authors.forename: Artur
authors.initials: A
authors.lastname: Fahradyan
authors.forename: William
authors.initials: W
authors.lastname: Magee
mesh_terms: D000293:Adolescent; D019882:Blepharoplasty; D002648:Child; D002675:Child, Preschool; D004483:Ectropion / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D005145:Face / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D015626:Tissue Expansion