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Risk factors for microvascular free flaps in pediatric lower extremity trauma

Z-Hye Lee1, David A Daar1, John T Stranix2

  • 1Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York.

Microsurgery
|January 25, 2019
PubMed

Insights

Free flap reconstruction in pediatric lower extremity trauma is safe. Arterial injury and vessel size mismatch significantly increase flap failure risk in children undergoing this procedure.

Area of Science:

  • Orthopedic Surgery
  • Microsurgery
  • Pediatric Trauma Care

Background:

  • Limited literature exists on free flap reconstruction for pediatric lower extremity trauma.
  • Free flap reconstruction is a critical reconstructive option for severe limb trauma.

Purpose of the Study:

  • To identify risk factors for free flap failure in pediatric lower extremity trauma reconstruction.
  • To evaluate the safety and outcomes of free flap reconstruction in pediatric trauma patients.

Main Methods:

  • Retrospective review of 53 free flaps performed for traumatic reconstruction in pediatric patients (<18 years).
  • Data collected included patient demographics, injury characteristics, flap details, and outcomes.
  • Statistical analysis included logistic regression and chi-squared analysis to identify risk factors for flap failure.

Main Results:

  • Arterial injury was associated with a significantly higher rate of flap failure (36.8% vs 8.8%, P=.020, RR=6.0).
  • Increasing degrees of arterial and venous size mismatch were linked to increased flap failure risk.
  • The presence of any venous size mismatch significantly increased flap failure risk (P=.041).

Conclusions:

  • Free flap reconstruction is a safe and viable option for pediatric lower extremity trauma, with outcomes comparable to adults.
  • Arterial injury and vessel size mismatch are significant risk factors for flap failure in this population.
  • Careful patient selection and meticulous surgical technique are crucial to optimize outcomes in pediatric free flap reconstruction.
Abstract

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