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Updated: Jul 23, 2026
Engineered Vascularized Muscle Flap
Published on: January 11, 2016
A 10-year experience of paediatric lower limb free flap surgery an evolution over time
1Plastic Surgery Registrar Southmead Hospital Southmead Hospital Plastic Surgery Department, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, United Kingdom.
Insights
Pediatric open lower limb fractures require aggressive management similar to adults. Scapular flaps provide favorable cosmetic and functional outcomes, and prompt care reduces infection risk.
Area of Science:
- Orthopedic Surgery
- Pediatric Trauma
- Reconstructive Surgery
Background:
- Open lower limb fractures are serious injuries with significant morbidity.
- While less common in children, their management parallels adult treatment protocols.
- A UK major trauma center's ten-year experience with pediatric open lower limb fractures is analyzed.
Purpose of the Study:
- To analyze pediatric patients treated for open lower limb fractures.
- To evaluate treatment pathways and outcomes in a major UK trauma center.
- To identify factors influencing recovery and complications in pediatric cases.
Main Methods:
- Retrospective analysis of pediatric patients with open lower limb fractures requiring soft tissue coverage (December 2011 - February 2023).
- Data collected included demographics, injury details, surgical timing, reconstruction methods, and outcomes.
- Analysis focused on time to wound excision, definitive surgery, flap types, operator grades, peri-operative support, and complications.
Main Results:
- 94 pediatric patients (mean age 11) were treated; most were ASA Grade I.
- Open tibial fractures were most common (61%); 71% had definitive fixation within 72 hours.
- Scapular/parascapular flaps were most frequent (52%); only 1 total flap failure occurred in 53 patients with data; no deep bone infections were reported.
Conclusions:
- Pediatric open lower limb fractures warrant aggressive treatment comparable to adults.
- Scapular and scapular/parascapular flaps are recommended for cosmetic and functional benefits.
- Prompt antibiotics and combined orthopedic/plastic surgery expertise are crucial for preventing deep bone infections.
Introduction:
Open lower limb fractures can carry significant morbidity and are typically managed with a well-defined care pathway. Thankfully such injuries are less frequent in paediatric populations. Management for children is the same as it is for adults. The aim of this study was to analyse paediatric patients undergoing treatment for open lower limb fractures at a UK major trauma centre over a ten-year period.
Method:
A retrospective analysis was performed on all paediatric patients with an open lower limb fracture that required soft tissue coverage, presenting to a major trauma centre with orthoplastic services from December 2011 to February 2023. Patient data was analysed according to demographics, co-morbidities, injury classification, time to wound excision, time to definitive surgery, soft-tissue reconstruction type and size, types of anastomoses used, grades of operators, peri‑operative use of inotropes and blood products, return to theatre in 24 h, flap survival and long-term complications.
Results:
We treated 94 patients with a mean age of 11 years old and mean weight of 46 .21kg The majority were ASA Grade I (80 %), additional co-morbidities included asthma, obesity and ADHD. Open tibial fractures were most common (61 %) followed by open foot fractures (18 %). Admission was within 24 h for 84 of the 86 patients for whom there was data, with 71 % having definitive fixation within 72 h of injury. The scapular or scapular/parscapular flap was most used (52 %) followed by an anterolateral thigh flap (29 %). A consultant was main operator in 70 % and a microsurgical fellow in 15 % of the cases recorded. Five cases out of 78 we had data for returned to theatre within the first 24 h of definitive surgery. with a mean of 18.5 h. In long term follow up there was 1 total flap failure and 1 flap that survived 60 % out of 53 patients there was data for. There were no deep bone infections.
Conclusion:
Paediatric patients should be treated as aggressively as adults with an open lower limb fracture. Scapular and scapular/parascapular flaps offer a more cosmetically and functionally appealing option. Prompt IV antibiotics, combined specialist orthopaedics and plastics experience help to reduce deep bone infections.
