Abstract: Objective　 To identify the causes of expansion failure during skin soft tissue expansion surgery within a retrospective cohort， and propose effective nursing strategies to reduce the failure rate and improve patient outcomes. Methods　A retrospective analysis was conducted on 58 cases receiving skin soft tissue expansion surgery in the Department of Plastic and Reconstructive Surgery from November 2022 to January 2024. The number of cases of expansion failure and its failure reasons were counted， and the improvement measures were put forward based on clinical nursing experience. Results　Out of 95 expansion attempts， 83 cases were successful， and 12 cases failed. The main causes of failure expansion included leakage of the expander（ 8 cases）， syringe leakage（ 2 cases）， flap necrosis（ 1 case）， and flap infection（ 1 case）. Among those expansion cases that exceeded the rated volume by more than 2 times， the proportion of expansion failure was about 10.6%， which was not statistically significant compared with the total expansion failure rate（ 12/95， 12.6%， P>0.05）， indicating that excess expansion did not increase the risk of expansion failure. Conclusion　Expansion failure in skin soft tissue expansion surgery is mainly related to leakage of equipment， flap infection and necrosis. In view of these reasons， nursing measures such as strengthening aseptic operation， appropriately selecting needles and injection techniques， and closely monitoring the blood supply of the flap could significantly reduce the occurrence of failure expansion.

Key words: Skin soft tissue expander surgery, 　 Expansion failure, 　 Nursing countermeasures, 　 Cause analysis, 　 Over-expansion