Risk Factors For Tissue Expander Infection In Scar Reconstruction: A Retrospective Cohort Study Of 2374 Consecutive Cases

Background: Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection.Methods: A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome.Results: A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of <= 1 year (odds ratio (OR), 2.07; p<0.001), larger volume of expander (200-400ml vs <200 ml; OR, 1.74; p=0.032; >400ml vs <200 ml; OR, 1.76; p=0.049), limb location (OR, 2.22; p=0.023) and hematoma evacuation (OR, 2.17; p=0.049) were associated with a high likelihood of expander infection. Disease duration of <= 1 year (OR, 3.88; p=0.015) and hematoma evacuation (OR, 10.35; p=0.001) were so related to high risk of treatment failure.Conclusions: The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of <1 year, expander volume of >200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.