Fifteen years of tissue expansion in limb reconstruction: outcomes and complications compared to non-limb applications

Abstract Background Tissue expansion serves as a cornerstone of plastic and reconstructive surgery, providing high-quality skin with optimal color, texture, and sensation. Despite its widespread use for burn sequelae and skin resurfacing, limb applications, particularly in the lower extremities, are linked to higher complication rates. This study retrospectively evaluates 15 years of experience with limb tissue expansion, comparing outcomes and complication rates to those of non-limb applications. Methods A retrospective review was conducted at Sheba Medical Center in Israel, encompassing 64 procedures that utilized 142 expanders across 49 patients from 2010 to 2024. Standardized departmental protocols were employed for soft-tissue expanders with distal ports. Data regarding demographics, indications, expander locations, and complications were analyzed. Results Among limb expanders (36 in 12 patients; mean age: 19.4 ± 6.1 years), the success rate was 88.9%, with complications occurring in 11.1% of cases, including expander exposure (5.6%) and wound dehiscence (2.8%). In the non-limb group (106 expanders in 37 patients; mean age: 13.3 ± 8.5 years), 87.7% were complication-free, while 12.3% experienced complications, including expander leaks (2.9%) and cellulitis (1.9%). Overall, the complication rates for limb (11.1%) and non-limb expanders (12.3%) were lower than those reported in the literature. Conclusions By adhering to standardized protocols and carefully selecting patients, clinicians can achieve results similar to those in non-limb procedures, offering patients a less invasive option that delivers both good aesthetic and functional outcomes. These findings, however, should be considered in the context of the small limb cohort. Level of evidence Level III, therapeutic study.