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Aggressive use of free flaps in children for burn scar contractures and other soft-tissue deficits
1Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, USA.
Insights
Free flap reconstruction using fasciocutaneous flaps is effective in pediatric patients, including burn reconstruction. This approach offers a successful, one-stage solution with outcomes comparable to adult procedures.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Microsurgery
Background:
- Free flap reconstruction in children presents perceived technical challenges and variable success rates.
- Fasciocutaneous free flaps are increasingly utilized for pediatric reconstructive needs, particularly in burn cases.
Observation:
- A 12-year study involved 38 free flaps in 30 pediatric patients (average age 10 years).
- The majority of flaps (84%) were fasciocutaneous, predominantly for burn deformities (25 cases).
- Mean hospital stay was 10 days, with an 11 major complication rate (29%).
Findings:
- Overall success rate was 84%, with 5 of 6 flaps salvaged after vascular thrombosis.
- Three flaps were aborted intraoperatively, and 3 were lost postoperatively due to complications.
- 39% of patients required minor secondary revisions during follow-up.
Implications:
- Free tissue transfer is an effective reconstructive option for pediatric patients, yielding successful one-stage reconstructions.
- Fasciocutaneous free flaps provide durable and aesthetically superior results for pediatric burn reconstruction.
- Morbidity associated with pediatric free flap reconstruction is similar to that reported in adult patients.
Abstract:
Free flap reconstruction in children is often undertaken with trepidation due to a variety of perceived technical difficulties and variable reports of success. The present report examines the efficacy of free tissue transfer in children, with particular attention given to the use of fasciocutaneous flaps in burn reconstruction. Over a 12-year period, 38 free flaps were done on 30 patients with an average age of 10 years (range, 16 months-17 years). Twenty-five flaps were done for burn deformities; 6 were done for chronic back wounds; 2 each were done for chronic lower extremity wounds, lower extremity traumatic defects, and a craniofacial deformity; and 1 flap was done following the resection of a large thigh vascular malformation. The vast majority of the flaps (84%) were fasciocutaneous: 13 groin, 9 scapula, 5 radial forearm, and 4 others. The mean hospital stay was 10 days and there were 11 major complications (29%). Five of 6 flaps were salvaged by reoperation following vascular thrombosis. Six flaps were unsuccessful (84% total success). Three of these flaps were aborted intraoperatively due to technical difficulties, while 3 others were lost postoperatively due to cellulitis, thrombosis, and patient-inflicted flap removal. During follow-up (range, 1-103 months), 39% of patients underwent a minor secondary revision of the flap reconstruction. This series demonstrates the efficacy of free tissue transfer in children in providing the majority of these patients with a successful, one-stage reconstruction with morbidity similar to that reported for adult patients. Moreover, the use of fasciocutaneous free flaps for pediatric burn reconstruction is shown to provide a durable and aesthetically superior treatment of these difficult problems.