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Free perforator flaps in children
Koenraad Van Landuyt1, Moustapha Hamdi, Phillip Blondeel
1Department of Plastic and Reconstructive Surgery, University Hospital Gent, Gent, Belgium. koenraad.vanlanduyt@ugent.be
Insights
Free perforator flaps are a reliable reconstructive option for children, offering excellent outcomes and reduced donor site morbidity. This technique is a valuable alternative to traditional free flaps in pediatric reconstructive surgery.
Area of Science:
- Plastic Surgery
- Pediatric Microsurgery
- Reconstructive Surgery
Background:
- Perforator flap elevation can be challenging but offers significant benefits.
- In pediatric patients, donor site options for free flaps are limited.
- Minimizing donor site morbidity is crucial for aesthetic, functional, and psychological well-being in children.
Purpose of the Study:
- To evaluate the efficacy and safety of free perforator flaps in pediatric reconstructive surgery.
- To assess the outcomes of perforator flaps in children with extensive soft-tissue defects.
- To establish perforator flaps as a preferred reconstructive option in pediatric cases.
Main Methods:
- A series of 23 consecutive free perforator flaps were performed in 20 children (ages 28 weeks to 16 years).
- The study included defects in the upper and lower limbs requiring extensive soft-tissue coverage.
- Flap types included deep inferior epigastric artery perforator, thoracodorsal artery perforator, and compound thoracodorsal artery perforator flaps.
Main Results:
- An overall success rate of 95.7% was achieved, with only one flap failure.
- Follow-up extended up to 7 years, demonstrating favorable long-term results.
- Outcomes compared positively with existing literature on adult perforator flaps and pediatric free flaps.
Conclusions:
- Free perforator flaps are a valuable alternative to traditional muscle or myocutaneous free flaps in pediatric reconstructive surgery.
- Perforator flaps significantly reduce donor-site morbidity, making them the preferred choice for the authors.
- This technique offers excellent reconstructive potential with improved patient outcomes in children.
Background:
Raising perforator flaps is said to be a tedious procedure. The benefits, however, are great. In adults, perforator flaps have proved their usefulness and reliability in various clinical situations. In children, donor sites for free flaps are particularly scarce because of the need for a long and reliable vascular pedicle of sufficient size. There is also the need to minimize donor-site morbidity from aesthetic, functional, and psychological perspectives.
Methods:
The authors present a series of 23 consecutive free perforator flaps performed by the first author in 20 children; ages at the time of operation ranged from premature (born at 28 weeks) to 16 years (mean age, 7 years 5 months). Three children presented with upper limb defects; the remaining 17 children sustained major soft-tissue defects of the lower limb. All the lesions necessitated extensive coverage with a free flap. Flaps used in this series included nine deep inferior epigastric artery perforator flaps, seven thoracodorsal artery perforator flaps, and seven compound ("chimera") thoracodorsal artery perforator flaps.
Results:
All flaps but one were successful. With a follow-up of up to 7 years, the results in this series compare favorably with those of perforator flaps in adults or pediatric free flaps in the literature.
Conclusions:
In children, as in adults, perforator flaps are a valuable alternative to the traditional muscle or myocutaneous free flap. Because of the added advantage of reducing donor-site morbidity, perforator flaps have become the authors' preferred option in reconstructive cases in children.
