Defect-Driven and Age-Related Patterns of Flap Selection in Pediatric Mandibular Reconstruction

Area of Science:

• Plastic Surgery
• Pediatric Craniofacial Surgery
• Microsurgery

Background:

• Pediatric mandibular reconstruction aims to restore continuity, function, and accommodate craniofacial growth.
• Vascularized osseous free flaps are standard, but donor site selection criteria related to defect type and patient age require clarification.
• Understanding these factors is crucial for optimizing long-term functional outcomes in young patients.

Purpose of the Study:

• To evaluate patterns of donor-site flap selection in pediatric mandibular reconstruction.
• To determine the influence of mandibular defect classification (Brown classification) and patient age on flap choice.
• To analyze associations between defect characteristics, age, donor-site selection, and flap outcomes.

Main Methods:

• Retrospective single-center cohort study of 75 patients (aged 1-18 years) undergoing microvascular mandibular reconstruction.
• Donor sites analyzed: fibula, iliac crest, and medial femoral condyle.
• Statistical analysis of associations between Brown defect class, patient age, donor-site selection, and flap loss.

Main Results:

• Fibula flaps were most common (52.0%), followed by iliac crest (44.0%).
• Donor-site selection significantly correlated with Brown defect classification (p < 0.001).
• While initial analysis suggested age-related patterns, these were not significant after stratifying by defect class; overall flap survival was 93.3%.

Conclusions:

• Mandibular defect characteristics, rather than patient age, are the primary drivers for donor-site selection in pediatric mandibular reconstruction.
• Observed age-related patterns in flap use likely stem from variations in defect morphology.
• A defect-oriented framework is clinically relevant, though flap selection remains individualized.