Efficacy of Free Flaps for Pediatric Trauma Patients in an Adult Trauma Center

ABSTRACT

Although many trauma centers are primarily “adult-oriented,” the presentation of unusual life- or limb-threatening wounds in children occasionally have mandated urgent microvascular tissue transfer for salvage. For these rare instances, should a microsurgical team accustomed to dealing with adult trauma patients even attempt to meet such a specialized challenge?

A retrospective analysis of all free flaps performed by the author's team in trauma patients from 1984 to 1993, revealed only 10 pediatric patients who had had 11 separate free flaps. Their ultimate success rate was 90.9 percent-statistically the same rate (87.0 percent) as for 93 adult free flaps. The majority of these pediatric flaps were for urgent coverage of the lower extremity and they were all successful, eliminating any need for traditional pedicled flaps during the same time period. Improvement in technical expertise and judgment seemed to be more important factors than actual chronological age in determining free-flap success in general, and in children in particular. Therefore, free flaps in the pediatric population can be appropriately performed in an adult trauma center.