Risk Factors for Complications of Tissue Expansion: A 20-Year Systematic Review and Meta-Analysis

Background: Tissue expansion is a widespread and accepted concept in plastic and reconstructive surgery and burn treatment but is also associated with a variety of complications. Most research does not reveal the risk factors for multiple complications of tissue expansion. To determine the risk factors for tissue expansion complications and to evaluate average complication rates, the authors performed a systematic review and meta-analysis of observational studies exploring risk factors for complications of tissue expansion. Methods: The MEDLINE (1966 to August 2010), EMBASE (1980 to August of 2010), PreMEDLINE, and HealthSTAR databases were searched for articles published from January of 1970 through August of 2010. Supplemental searches were performed to include Internet resources and reference lists and by contacting experts in the field. Two reviewers extracted data independently. Data were combined using the Mantel-Haenszel method (random-effects models) and further analyzed by multiple regression. Results: Forty-two retrospective observational studies were included, yielding 5925 patients who underwent plastic and reconstructive surgery with tissue expansion. The total average complication rate was 17.44 percent, and the most common complication was infection (4.58 percent). The lower limb (with the exception of the breast) was more likely than other body sites to develop complications (odds ratio, 2.80; 95 percent confidence interval, 1.14 to 6.86), and the safest site at which to perform tissue expansion was the trunk (odds ratio, 0.78; 95 percent confidence interval, 0.45 to 1.33). Conclusions: This systematic review and meta-analysis provides evidence that complications for tissue expansion are associated with specific risk factors, such as the site, the patient's smoking habits, and radiation therapy. The available data regarding average rates are also summarized. (Plast. Reconstr. Surg. 128: 787, 2011.)