Free flap coverage of upper and lower limb tissue defects in children: a series of 22 patients

Free tissue transfer has become the most important means of limb salvage treatment after severe trauma. This one-step procedure shortens healing and hospitalization time and minimizes the danger of infection. However, very few studies have considered the use of free tissue transfer for the reconstruction of traumatic limb injuries in children. This study reports 22 such cases treated in the authors' unit between 1993 and 2000 (17 boys and 5 girls; mean age, 8.9 years; age range, 18 months-15 years; 16 lower and 6 upper limbs). All flaps were indicated for repair of acute traumatic defects (20-500 cm2). Five different flaps were used: 12 scapular, 4 latissimus dorsi, 4 serratus anterior, 1 groin, and 1 temporalis fascia. All were successful, except for partial necrosis with the free groin flap. Three flaps requiring reexploration for venous insufficiency had a successful outcome. The microsurgical success rate in this pediatric population is very high, and the state and size of the donor site and recipient vessels have caused no problems. No long-term complications have been noted (mean follow-up, 3.8 years).