Risk factors of tissue-expansion failure in burn-scar reconstruction

Background: Tissue expansion has become invaluable for burn-scar reconstruction. However, its use is hindered by the complications that often result in expansion failure. This study attempts to identify the risk factors of expansion failure in burn patients, as such factors have not been clearly defined. Methods: This study included 62 tissue expansions in 37 burn patients from January 2001 to June 2009. Factors including patient's age, sex, co-morbidities, expander size, implantation site, volume injected at implantation, preinflation volume ratio (PVR = volume injected at implantation/expander size), final inflation volume ratio (FIVR = cumulative volume injected at completion of expansion/expander size) and expansion duration were analysed. Cases were allocated into success (n = 53) and failure (n = 9) groups. Logistic regression was used in multivariate analysis for identifying predictors of expansion failure. Results: The mean age of the patients was 29.6 years. The male to female ratio was 1:1.4. Expansion complication and failure rates were 53% (n = 33) and 14.5% (n = 9), respectively. The risk factors statistically correlated to expansion failure (p < 0.05) were age, expander size, PVR and implantation at lower limb. Expansion of lower limbs carried a risk of failure 43 times greater than other sites. Conclusion: We conclude that tissue expansion should be avoided in older patients and in lower limbs. The largest possible expander size and inflation at time of implantation should be used to lower the risk of expansion failure