Risk factors for tissue expander complications: A retrospective cohort study of 1073 expanders

We sought to delineate risk factors contributing to complications related to tissue expanders and furnish evidence to inform clinical prevention and management strategies. This retrospective cohort analysis included patients who underwent tissue expansion at our institution. Conventional and generalized estimating equations (GEE) univariate analyzes were used to identify potential risk factors for overall and specific complications. Variables with a significance threshold of P<0.20 were incorporated into multivariate GEE models. The study included a cohort of 539 patients and involved the use of 1073 tissue expanders. A total of 103 complications (9.60%) were documented. Among these complications, expander rupture (4.75%) and skin ulceration (3.54%) were the most frequently observed adverse events. Multivariate GEE analysis identified low preoperative RBC count (P=0.005) and larger expander volume (P=0.003) as independent predictors of overall complications. Low preoperative RBC count (P=0.002) was independently associated with increased risk of rupture. Head and trunk expander location exhibited a borderline association (P=0.053) with increased risk of rupture. Furthermore, older age (P=0.021), larger expander volume (P=0.009), and non-head/trunk expander location (P=0.005) were independently linked to skin ulcer. The findings indicate that risk factors differ by complication types and clinicians should develop targeted preventive strategies tailored to patients exhibiting these high-risk characteristics during tissue expansion procedures.