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Application of vertical transposition flap in closure for large facial soft tissue defects in children
Rui Feng1, Jigang Chen1,2, Yining Wang1
1Department of Burn and Plastic Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Insights
Vertical transposition flaps effectively repair large facial defects in children, offering good cosmetic outcomes. Careful patient selection and flap design are crucial for optimal results in pediatric facial reconstruction.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Facial Reconstruction
Background:
- Transposition flaps are common for facial defect repair.
- Limited research exists on their use in children with large facial defects.
Purpose of the Study:
- Investigate surgical techniques and principles for vertical transposition flaps in pediatric patients with large facial defects.
- Evaluate the efficacy and outcomes of this method in children.
Main Methods:
- Retrospective review of pediatric patients treated with vertical transposition flaps for large facial defects (Jan 2014 - Dec 2021).
- Data collected included demographics, lesion characteristics, surgical details, complications, and outcomes.
Main Results:
- 122 children (average age 3.3 years) with large facial defects (melanin or sebaceous nevi) were analyzed.
- Flap necrosis occurred in 8.2% of patients, and transient mouth/eyelid traction in 4.1%.
- All patients achieved acceptable cosmetic outcomes with some scarring.
Conclusions:
- Vertical transposition flaps are effective for repairing large pediatric facial defects, particularly on the forehead, cheek, and mandible.
- While effective, the technique has limitations, necessitating careful patient and flap design selection.
Background:
While transposition flap is widely used for the repairs of facial defects, few studies has reported its application among children with large defects. In this study, we aimed to investigate the surgical techniques and principles in different locations on face of vertical transposition flap in children.
Methods:
We retrospectively reviewed our hospital database and identified children who were treated with vertical transposition flap for large facial defects between January 2014 and December 2021. Information was collected including patients' demographics, location and dimension of the lesion, surgical procedure, additional surgeries, complications, and outcomes.
Results:
A total of 122 patients (77 boys, 63.1%) were included in this study. The average age for participants was 3.3 years (3 months to 9 years). One hundred and four (85.3%) patients had melanin nevus and 18 (14.8%) had sebaceous nevus. The average size of defects was 5.8 cm2 (ranging from 0.8-16.5 cm2). Ten patients (8.2%) suffered from dermal layer or full-thickness necrosis in the distal part of their flaps, They all recovered after conservative treatment and there were noticeable scars at discharge. Five patients (4.1%) had slight traction of the mouth and eyelid, all recovered about 2 week after surgery. An acceptable cosmetic outcome was achieved for all the patients at last time follow-up.
Conclusions:
Repairing large facial defects with vertical transposition flap is effective in Children, especially on forehead, cheek and mandible. However, this technique is far from perfect. Careful selection of appropriate patients and flap design might be needed.
