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

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Karel Ey Claes1, Nathalie A Roche1, Dries Opsomer1

  • 1Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium.

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|March 23, 2019
PubMed

Insights

The anterolateral thigh (ALT) flap is the preferred method for pediatric lower limb soft tissue reconstruction due to its low complication rate. Other free flaps like the radial forearm (RFA) flap also show promising results.

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.
Abstract

Keywords:
ChildrenFree flapFree tissue transferLower limbReconstruction

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