This study aims to identify possible risk factors for complications in tissue expansion in all anatomical regions except the breast. The overall complication rate of tissue expansion is up to 48%. Over the 10-year study period, 34 patients had placement of subcutaneous tissue expanders (excluding breast reconstruction). In total, 71 expanders were used. Parameters for each patient including age, gender, smoking history, body-mass index, American Society for Anaesthetists (ASA) status, prevalence of diabetes or autoimmune diseases and mean arterial pressure were all recorded. Complications included dehiscence, necrosis, infection, seroma and haematoma and expander leakage. In this series, complications arose in 36.6% of cases. Full therapy success occurred in 66.2% of expanders. The authors performed a logistic regression analysis that revealed that women had a 4.3 fold higher risk of developing complications in comparison to men. There was a 4.9 fold higher complications rate in expanders located in the extremity in comparison with those placed in the scalp or head and neck region. A low BMI and higher expander volumes were also strongly associated with complications. Expanders for burns scar reconstruction were not associated with greater risk for complications. The authors clearly state the limitations of their study. They mention that their patient cohort were relatively heterogeneous in regards to age, anatomical region of expander and expander size. Patients were also treated by different surgeons, which may bias results. Regardless, this is an interesting study with statistically significant results revealing that complications are more common in females, in lower limb expanders and in those with a lower BMI. This study will help with patient selection when considering the potential success of an expander for reconstruction.

Complications in tissue expansion: a logistic regression analysis for risk factors.
Smolle C, Tuca A, Wurzer P, et al.

BURNS

2017;43(6):1195-202.
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Jill Baker

St John’s Hospital, Livingston, UK

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