Free flaps for lower limb soft tissue reconstruction in children: Systematic review

Area of Science:

• Pediatric Microsurgery
• Reconstructive Surgery
• Limb Reconstruction

Background:

• Microsurgery techniques have advanced, leading to a preference for free flaps in pediatric soft tissue defect reconstruction.
• This evolution reflects a move towards more sophisticated reconstructive options in pediatric care.

Purpose of the Study:

• To systematically compare complication rates between free perforator/fasciocutaneous flaps and free muscular/myocutaneous flaps for pediatric lower limb soft tissue defects.
• To assess the frequency and severity of complications associated with each reconstructive approach.

Main Methods:

• A systematic review was conducted using major scientific databases (PubMed, Web of Science, Embase, Scopus, Cochrane Library).
• Inclusion criteria were predefined to ensure a focused analysis of relevant studies.

Main Results:

• The anterolateral thigh (ALT) flap emerged as the most frequent and successful option, with an 11.3% complication rate and minimal flap loss.
• The latissimus dorsi (LD) flap and thoracodorsal artery perforator (TDAP) flap had comparable complication rates (32% vs. 39%), with LD flaps experiencing fewer failures.
• The radial forearm (RFA) fasciocutaneous flap is a viable alternative, demonstrating a low complication rate (16%) and no flap loss.

Conclusions:

• The ALT flap is identified as the optimal reconstructive method for pediatric lower limb soft tissue defects.
• Further prospective research is needed to establish definitive guidelines for free flap reconstruction in pediatric lower limb defects and optimize long-term outcomes.