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Surgical delay increases the survival of expanded random-pattern flap in pediatric patients
Jeong Hyun Ha1,2, Se Yeon Lee3, Tae Hyun Choi4
1Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea. hjeong907@gmail.com.
Insights
Surgical delay improves outcomes for expanded flaps in pediatric patients with extensive skin lesions, offering comparable results to conventional methods even in challenging cases.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Tissue Expansion
Background:
- Random pattern flaps are crucial for extensive skin lesions but ideal designs are not always feasible.
- Tissue expansion is a common technique, but outcomes can be limited by flap design constraints.
Purpose of the Study:
- To evaluate the effectiveness of surgical delay in pediatric patients undergoing tissue expansion for extensive skin lesions.
- To compare outcomes between conventional tissue expansion and tissue expansion with surgical delay.
Main Methods:
- Retrospective cohort study of pediatric patients undergoing tissue expansion.
- Surgical delay technique applied for unfavorable flap conditions.
- Measurement of lesion and flap dimensions from medical photographs.
Main Results:
- Surgical delay group had more narrow-based flaps (p<0.001).
- Partial flap loss and excised area-to-inflation ratio were comparable between groups (p=0.093, p=0.194).
- Viable flaps in the surgical delay group showed significantly narrower bases (p<0.01).
Conclusions:
- Surgical delay provides outcomes comparable to well-designed random flaps in challenging pediatric cases.
- This technique benefits patients with large skin lesions and limited expansion areas.
- Surgical delay is a valuable adjunct for optimizing expanded flap outcomes in pediatric plastic surgery.
Abstract:
Despite the aid of tissue expansion, the ideal design of random pattern flap is not always available in patients with extensive skin lesions. We investigated the effectiveness of surgical delay on expanded flaps in pediatric patients. Retrospective cohort study was performed on patients who underwent tissue expansion surgery for extensive skin lesions at Seoul National University Children's Hospital. The surgical delay technique was employed for patients with unfavorable flap conditions related to location or transposition angles. The dimensions of skin lesions and flaps were measured based on medical photographs. Fifty patients underwent a total of 66 tissue expansion procedures (49 conventional procedures among 41 patients, 17 surgical delay procedures among 15 patients) from January 2016 to September 2019. Although flaps in the surgical delay group were more narrow-based (p < 0.001), the partial flap loss rate and excised area-to-inflation amount ratio was comparable between the two groups (p = 0.093 and p = 0.194, respectively). Viable flaps, excluding postoperative necrosis, in the surgical delay group were significantly more narrow-based in terms of the length-to-base width ratio and the area-to-base width ratio compared to conventional group (p < 0.01, p < 0.01). Surgical delay can result in outcomes comparable to well-designed random flaps, even in disadvantageous conditions. Patients with large skin lesions but limited areas for expansion may benefit from surgical delay.
