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Published on: June 15, 2020
Microvascular reconstruction in children-a report of 46 cases
Eeva Konttila1, Virve Koljonen, Susanna Kauhanen
1Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
Insights
Microvascular free tissue transfers are highly successful in pediatric patients with severe tissue defects, offering a viable reconstructive option. Further multicenter studies are recommended for standardized preoperative assessment and antithrombotic therapy guidelines in pediatric microsurgery.
Area of Science:
- Pediatric Surgery
- Microsurgery
- Plastic Surgery
Background:
- Retrospective analysis of microvascular free tissue transfers in pediatric patients.
- Tissue defects caused by trauma, tumor resection, congenital malformations, meningococcal septicaemia, and scars.
Purpose of the Study:
- To evaluate the efficacy and outcomes of microvascular free flap surgery in pediatric patients.
- To identify the most suitable reconstructive techniques for severe tissue defects in children.
Main Methods:
- Retrospective review of 46 pediatric patients undergoing microvascular free flap surgery between 1986 and 2004.
- Collaboration between Pediatric Surgery and Plastic Surgery departments.
- Mean follow-up period of 50 months.
Main Results:
- Overall success rate of 96% for microvascular free flaps.
- Vascularized fibula was the most frequently used flap, particularly for lower extremity reconstruction (25 cases).
- Reoperations were required in 8 cases (hematoma, thrombosis, or impaired blood flow), with successful flap salvage in all reanastomosis attempts.
Conclusions:
- Microvascular free flap reconstruction is a preferred treatment for severe pediatric tissue defects.
- Standardized guidelines for preoperative assessment and antithrombotic therapy in pediatric microsurgery are needed, suggesting a role for multicenter studies.
Background:
: We report microvascular free tissue transfers in pediatric patients in a retrospective series.
Methods:
: Forty-six children were treated in collaboration between the departments of Pediatric Surgery and Plastic Surgery, Helsinki University Hospital between 1986 and 2004 for microvascular free flap surgery. Trauma, tumor resection, congenital malformation, meningococcal septicaemia, and scars caused the tissue defects. The mean follow-up was 50 months.
Results:
: The overall success rate was 96%. Twenty-five free flaps were transferred to the lower extremity. The most used flap was vascularized fibula. Preoperative angiography or intraoperative anticoagulants were not routinely used. Early reoperations were needed in four cases due to hematoma and in four cases due to thrombosis or impaired blood flow. All attempts of reanastomosis lead to salvage of the flap.
Conclusion:
: In cases of severe tissue defects in pediatric patients, microvascular free flap reconstruction is a treatment of choice. A multicenter study for guidelines on preoperative assessment and antitrombotic therapy in pediatric microsurgery is warranted.
