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Novel use of a supraclavicular transverse cervical artery customised perforator flap: a paediatric emergency
R T Dolan1, F O'Duffy, D M Seoighe
1Department of Plastic & Reconstructive Surgery, Children's University Hospital, Temple St., Dublin 1, Ireland. roshdolan@hotmail.com
Insights
Piriform fossa perforation in children is a rare emergency. A customized cervical artery perforator flap successfully reconstructed a large defect, saving a septic infant.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Plastic and Reconstructive Surgery
Background:
- Piriform fossa perforation is a rare, life-threatening pediatric emergency.
- Restoring aerodigestive continuity after perforation presents a significant reconstructive challenge.
Observation:
- A 7-month-old infant presented with hemoptysis, cough, and respiratory distress.
- Contrast swallow revealed retropharyngeal contrast extension, indicating a piriform fossa perforation.
- A 3.0 cm x 1.0 cm perforation was identified in the left posterolateral piriform fossa.
Findings:
- The piriform fossa defect was successfully repaired using a supraclavicular transverse cervical artery customized perforator flap.
- This fasciocutaneous island flap provided timely mobilization, reliable blood supply, and adequate tissue for reconstruction.
- The flap served as a life-saving intervention in a critically ill, septic infant.
Implications:
- This case demonstrates the novel and effective use of a customized perforator flap for extensive piriform fossa defects in pediatric emergencies.
- The flap design offers a viable reconstructive option for complex aerodigestive injuries in acute pediatric settings.
- This approach highlights a successful strategy for managing potentially fatal pediatric airway emergencies.
Abstract:
Perforation of the piriform fossa is a rare, potentially life-threatening paediatric emergency. Prompt diagnosis and early operative intervention is key to patient survival, yet restoring aerodigestive continuity can pose a significant reconstructive challenge. A seven-month old baby girl presented to an emergency department acutely unwell with a twenty-four-hour history of haemoptysis, cough and worsening respiratory distress. A contrast swallow demonstrated extension of contrast into the retropharyngeal region necessitating immediate surgical intervention. A 3.0 cm×1.0 cm perforation within the left posterolateral piriform fossa was identified. The defect was repaired with a supraclavicular transverse cervical artery customised perforator flap. This was inset into the piriform fossa luminal defect as a life-saving procedure. Following a stormy post-operative course, the child was discharged home on day 28 of admission and admitted electively 6 weeks later for division of flap pedicle. This case highlights the novel use of this fasciocutaneous island flap to reconstruct an extensive, potentially fatal, piriform fossa defect in an acute paediatric setting. This simple flap design offers timely mobilisation, reliable blood supply, adequate tenuity and surface area, to reconstruct this extensive defect as a life-saving intervention in a profoundly septic child.
