Risk Factors for Tissue Expander-Related Infections in Pediatric Scar Reconstruction: A 10-Year Retrospective Study.

Background: Tissue expansion addresses limited soft-tissue availability and provides natural-looking skin for scar reconstruction. However, infection is a common complication in expander surgery. This 10-year retrospective cohort study was performed to investigate the infection risk factors in pediatric scar reconstruction.

Methods: This single-center observational cohort study was conducted at the Central Hospital Affiliated with Shandong First Medical University, China, and analyzed data from pediatric patients undergoing tissue expander surgery for scar reconstruction from January of 2012 to June of 2022. Patients were selected, were divided into groups with or without infection, and their demographic and clinical data were analyzed. Propensity score matching ensured balanced comparisons, and logistic regression identified infection risk factors.

Results: Among the 4539 patient records, 1756 eligible pediatric patients were included (142 with infections; 1614 without infections). Multivariate analysis revealed that factors increasing infection risk included having 3 or more expanders (OR, 2.39, P < 0.05), a total expander volume of 300 cc or more (OR, 2.33, P < 0.05), back or gluteal implants (OR, 1.33, P < 0.05), lack of antibiotic prophylaxis (OR, 0.65, P < 0.05), and absence of hematoma evacuation (OR, 3.29, P < 0.05). Microbiological analysis found no significant bacterial differences among antibiotic prophylaxis groups, with Staphylococcus aureus being the predominant bacterium in infections.

Conclusions: Patients with multiple expanders, larger expander volumes, back or gluteal implants, lack of antibiotic prophylaxis, and hematoma evacuation absence have higher infection risks. Short-term (<24 hours) use of S. aureus -sensitive antibiotics after surgery may benefit pediatric infection risk reduction.

Clinical question/level of evidence: Risk, III.