Tissue expansion in children has been associated with complication rat
es of 20 to 40 percent. A critical analysis of 6 years' (1988-1993) ex
perience with 180 expanders placed in 82 consecutive children was perf
ormed to identify those factors which predispose to complications. Maj
or and minor complications each occurred in 9 percent of patients. The
factors associated with a statistically significant increase in compl
ications were burns and soft-tissue loss, patient age under 7 years, u
se of internal expander ports, and a history of two or more prior expa
nsions. In addition, complications were significantly more likely to o
ccur within the first 90 days than during any subsequent expansion. Fa
ctors that did not influence complication rate included patient gender
, wound drainage upon expander insertion or removal, intraoperative us
e of antibiotic irrigation, number of expanders placed, use of customi
zed expanders, and operating surgeon.