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Free flap reconstruction in paediatric patients with head and neck cancer: clinical considerations for comprehensive
1Department of Maxillofacial Surgery, Jiamusi Central Hospital, Heilongjiang, China.
Insights
Free flap reconstruction is feasible in pediatric head and neck cancer (HNC) patients. However, caution is advised with tracheotomies and nasal feeding tubes due to associated complications.
Area of Science:
- Oncology
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Head and neck cancer (HNC) in pediatric patients presents unique reconstructive challenges.
- Free flap reconstruction is a complex procedure with potential complications in young patients.
Purpose of the Study:
- To investigate the clinical factors and outcomes of free flap reconstruction in pediatric patients with HNC.
- To identify risk factors for complications in this patient population.
Main Methods:
- Retrospective analysis of 47 pediatric patients (≤14 years) undergoing free flap reconstruction for HNC from 2009-2018.
- Collection and analysis of clinical, pathological, and imaging data.
- Evaluation of operative time, blood loss, and complication rates.
Main Results:
- Seventeen patients required tracheotomy, which was significantly associated with medical and total complications (P=0.003 and P=0.024, respectively).
- Observed complications included pulmonary infections, diarrhea, pulmonary aspiration, hematoma, wound dehiscence, salivary fistula, effusion, and tracheotomy hemorrhage.
- Microvascular reconstruction was confirmed as a viable option for pediatric HNC patients.
Conclusions:
- Free flap reconstruction is a viable option for pediatric HNC.
- Tracheotomy and nasal feeding tubes should be used cautiously in this population.
- Thorough preoperative assessment, meticulous surgical technique, and diligent postoperative care are crucial for minimizing complications.
Abstract:
Free flap reconstruction after resection in paediatric patients with head and neck cancer (HNC) has various clinical challenges, which have not yet been fully investigated. This retrospective study was implemented to investigate these factors. Paediatric patients (≤14 years old) who underwent free flap reconstructions following surgery for HNC at a tertiary referral centre during the years 2009-2018 were included. Clinical, pathological, and imaging data were collected and analysed. Overall, 47 patients were included, 26 male and 21 female. Thirty-four patients were ASA status I and 13 were ASA status II. The median operative time was 415 minutes, while the median intraoperative blood loss was 500 ml. Seventeen patients had a tracheotomy. Fourteen medical complications (six pulmonary infection, six diarrhoea, two pulmonary aspiration) and six surgical complications (one haematoma beneath flap, two wound dehiscence, one salivary fistula, one effusion, one tracheotomy haemorrhage) were observed. Tracheotomy was associated with medical complications (P = 0.003) and total complications (P = 0.024). It was confirmed that microvascular reconstruction can be adopted in paediatric HNC patients, while tracheotomy and nasal feeding tubes should be used with caution. Comprehensive preoperative assessment, gentle handling of the tissues during operative procedures, and appropriate postoperative management will reduce the risk of complications.
