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 surgeries. This 10-year retrospective cohort study aims 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 surgeries for scar reconstruction from January 2012 to June 2022. Patients were carefully selected, and after grouping into infection and non-infection categories, their demographic and clinical data were analyzed. Propensity score matching (PSM) ensured balanced comparisons, and logistic regression identified infection risk factors. Results: Among the 4,539 patient records, 1,756 eligible pediatric patients were included (142 with infections, 1,614 without). Multivariate analysis revealed that factors increasing infection risk included having three 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 (< 24h) use of Staphylococcus aureus-sensitive antibiotics post-surgery may benefit pediatric infection risk reduction.