Free tissue transfer for leg reconstruction in children

Area of Science:

• Orthopedic Surgery
• Pediatric Plastic Surgery
• Microsurgery

Background:

• Lower limb trauma and scar contractures in children often require complex reconstructive procedures.
• Free tissue transfer offers a viable option for these challenging cases, particularly in the distal leg.

Purpose of the Study:

• To evaluate the safety and efficacy of free tissue transfer in pediatric lower limb reconstruction.
• To identify factors influencing vascular success and postoperative complications.

Main Methods:

• Retrospective analysis of 25 free tissue transfers in 23 children (ages 2-14) over 8 years.
• Reconstruction focused on distal leg defects following trauma or scar contracture release.
• Data collected on patient demographics, injury patterns, surgical outcomes, and complications.

Main Results:

• An overall vascular success rate of 96% was achieved, with three re-explorations for vascular insufficiency.
• Postoperative complications occurred in 28% of patients, predominantly in those with major associated injuries.
• Long-term issues including gait disturbance, flap ulcers, and contractures were observed in a significant proportion of patients.

Conclusions:

• Free tissue transfer is a reliable and safe reconstructive technique for pediatric lower limb defects.
• Associated proximal injuries on the ipsilateral leg increase the risk of vascular complications.
• Meticulous preoperative assessment, surgical planning, and postoperative care are crucial for optimizing outcomes in pediatric patients.