Postoperative Complications of Soft Versus Rigid Based Tissue Expanders in Burn and Soft Tissue Reconstruction

Abstract Introduction Tissue expanders are a well-established method in reconstructive surgery. Tissue expander reconstructions may be divided between breast-related and non-breast related reconstructions. While prior studies have investigated diverse aspects of expanders' complications in both indications, there is a paucity of published research regarding the impact of expander base rigidity on complications. This study aims to investigate the association between expander base type rigidity and complications in non-breast reconstructions. Methods We conducted a retrospective analysis of non-breast-related tissue expansion procedures in patients aged 6 months to 76 years, treated at a tertiary medical center from 2000 to 2021. We compared soft-based and rigid-based expanders, analyzing demographic factors, anatomical placement, shape, and indications using mixed models and multivariate Poisson regression to estimate the risk ratio (RR) and adjusted for confounders. Results A total of 86 patients underwent non-breast-related tissue expansion procedures, utilizing 186 expanders, of which 130 were rigid-based and 56 soft-based. Post-burn reconstruction was the indication in 54% of rigid-based and 53% of soft-based expanders used. The groups did not differ in demographic characteristics. Univariate analysis revealed complication rates of 18% for the soft-based and 50% for the rigid-based groups (p.001). Another significant difference was found specifically in major complications (16% vs. 45% respectively, p.001), with wound infection and expander exposure as the most significant complications (5.4% vs. 25.0%, p=.045 and 5.4% vs. 23.0%, p=.013, respectively). We did not find associations between the geometric shape or anatomical placement of the tissue expanders and complication rates. Conclusions Soft based tissue expanders had a significantly lower rate of complications as compared to rigid based tissue expanders, particularly in major complications including wound infection and expander exposure. Applicability of Research to Practice Based on the results of this retrospective study we recommend on preferring soft based tissue expanders for burns and other non-breast tissue expander reconstructions. Funding for the study N/A.