Free Flap Reconstruction of Extremity Defects in Pediatric Patients

Abstract

Background Microsurgical reconstruction of extremity defects with free flaps has been carried out for many years. The aim of this retrospective study is to characterize free flap surgery on children of 1 to 7 years old by evaluating a series of 20 cases of free flap surgeries that have been performed in pediatric patients.

Methods From February 2014 to January 2018, 20 patients, 10 boys and 10 girls aged from 1 to 7 years (average, 4.6 years), were engaged in this study. Several types of free flaps were used, including anterolateral thigh flaps (ALT), inferior ulnar collateral artery flap, latissimus dorsi flap, medial plantar flap, fibular osteocutaneous flap and hallux toenail flap. After operations, follow-up period was at least for 2 years and the average follow-up period was 48.5 months. The long-term outcomes were estimated by questionnaires derived from the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collection Instrument (PODCI).

Results A total of 21free-flap reconstructions were performed on 20patients, including 15 ALT, 3 composite flaps, and 3 other cutaneous flaps. The size of the tissue flap ranged from 1.5 to 280 cm2 (average, 74.1cm2). The diameter of the anastomosed artery of the flap ranged from 0.7 to 1.2 mm. Among the 21 flaps, 20 survived and the success rate was about 95 %. Contour adaption was achieved in all flaps. Fifteen children received a secondary operation for debulking or functional improvement. Secondary deformity was present in 3 children, among which ankle joint valgus was seen in two children and a flexion deformity of injured toe occurred in one child. The mean global functioning score of PODCI was 94 (ranging from 81 to 98, maximum 100).

Conclusion The success rate of free-flap surgery in pediatric patients was comparable to that achieved in adults. Post-operative caring for pediatric patients was easier than expected. For pediatric patients, the final outcomes were not varied remarkably from different types of free tissue transfer.

Zusammenfassung

Methoden Von Februar 2014 bis Januar 2018 nahmen 20 Patienten, 10 Jungen und 10 Mädchen im Alter von 1 bis 7 Jahren (Durchschnittsalter 4,6 Jahre), an dieser Studie teil. Es wurden mehrere Arten von freien Lappenplastiken verwendet, darunter anterolaterale Oberschenkellappen (ALT), Lappen der A. collateralis ulnaris inferior, des M. latissimus dorsi und der A. plantaris medialis sowie osteokutane Fibulalappen und Lappen des Großzehnnagels. Nach den Operationen wurden die Patienten über einen Mindestzeitraum von 2 Jahren nachbeobachtet, wobei der durchschnittliche Nachbeobachtungszeitraum bei 38,5 Monaten lag. Die Langzeitergebnisse wurden anhand von Fragebögen in Anlehnung an das Pediatric Outcomes Data Collection Instrument (PODCI) der American Academy of Orthopaedic Surgeons beurteilt.

Ergebnisse Insgesamt wurden 21 Rekonstruktionen mittels freier Lappenplastiken bei 20 Patienten durchgeführt, darunter 15 ALT, 3 zusammengesetzte Lappen und 3 andere kutane Lappenplastiken. Die Größe der Gewebelappen lag zwischen 1,5 und 280 cm² (Durchschnitt 74.1 cm²). Der Durchmesser der anastomosierten Arterien der Lappen lag zwischen 0,7 und 1,2 mm. Von den 21 Lappen blieben 20 erhalten und die Erfolgsrate betrug etwa 95 %. Bei allen Lappenplastiken gelang die Konturenanpassung. Fünfzehn Kinder wurden zur Reduktion der Tumormasse oder zur Funktionsverbesserung ein zweites Mal operiert. Sekundäre Deformitäten lagen bei 3 Kindern vor, bei 2 Kindern ein Valgus des Sprunggelenks und bei einem eine Flexionsdeformität des verletzten Zehs. Der mittlere globale PODCI-Score zur Funktionsfähigkeit lag bei 94 (Spannweite 81 bis 98, Maximum 100).

Schlussfolgerung Die Erfolgsrate chirurgischer Eingriffe mit freien Lappenplastiken bei pädiatrischen Patienten war mit der von Erwachsenen vergleichbar. Die postoperative Versorgung der pädiatrischen Patienten gestaltete sich einfacher als erwartet. Bei pädiatrischen Patienten unterschieden sich die Endergebnisse der verschiedenen Arten von freiem Gewebetransfer nicht nennenswert voneinander.

Key words

Pediatric patients - tissue defect - free flap - long-term outcome

Schlüsselwörter

Pädiatrische Patienten - Gewebedefekt - freie Lappenplastik - Langzeitergebnis

Publication History

Received: 26 September 2020

Accepted: 21 December 2020

Article published online:
09 August 2021

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