COMPARISON OF MICROVASCULAR FREE TISSUE TRANSFER IN ADULT AND PEDIATRIC PATIENTS
AbstractBackground: Free tissue transfer is a routine practice in adults with good success rates. Further advances in techniques and microsurgical skills have proved that free tissue transfer in paediatric population is feasible, reliable and safe. Methods: This study is conducted to compare anastomosis duration, total general anaesthesia duration, hospital stay and outcomes of flaps (survival, partial loss, complete loss, complications ) in paediatric group ( age <15 years ) and adult group ( 15 -70 years age). All patients with large soft tissue defects, congenital defects , traumatic defects and post tumor extirpation were included in this study from December 1st 2017 to May 30th2018. These patients underwent different microsurgical procedures, the reconstructive armamentarium included use of Latissimus dorsi flap, Anterolateral thigh flap, Fibula flap, Radial forearm flap, functioning Gracillis muscle, iliac crest flap, Deep inferior epigastric artery perforator flap and Rectus abdominis muscle flap. Post-traumatic defects were the commonest indication of free tissue transfer in Paediatric population while post tumor extirpation defects were commonest defects encountered in adult population. Results: On average the total anaesthesia duration is slightly shorter in paediatric group than in adult patients while anastomosis duration is slightly shorter in adults then in paediatric patients .The overall complication rate is comparable in both groups and all the flaps survived well. Conclusion: Microsurgical free tissue transfer can be confidently attempted in children and their results are comparable with those of adult group.
Harii K, Ohmori K. Free groin flaps in children. Plast Reconstr Surg 1975;55(5):588–92.
Ohmori K, Harii K, Sekiguchi J, Torii S. The youngest free groin flap yet? Br J Plast Surg 1977;30(4):273–6.
Claes K. Systematic review: free flaps for lower limb reconstruction in children. [Internet]. [cited 2018 May]. Available from: https://lib.ugent.be/fulltxt/RUG01/002/350/465/RUG01-002350465_2017_0001_AC.pdf
Van Landuyt K, Hamdi M, Blondeel P, Tonnard P, Verpaele A, Monstrey S. Free perforator flaps in children. Plast Reconstr Surg 2005;116(1):159–69.
Yildirim S, Aköz T. Big-toe replantation in a three-month-old child: case report. J Reconstr Microsurg 2004;20(5):373–5.
Parry SW, Toth BA, Elliott LF. Microvascular free-tissue transfer in children. Plast Reconstr Surg 1988;81(6):838–40. Ref no 6,12&21 are same
Devaraj VS, Kay SP, Batchelor AG, Yates A. Microvascular surgery in children. Br J Plast Surg 1991;44(4):276–80.
Van Beek AL, Wavak PW, Zook EG. Microvascular surgery in young children. Plast Reconstr Surg 1979;63(4):457–62.
Banic A, Wulff K. Latissimus dorsi free flaps for total repair of extensive lower leg injuries in children. Plast Reconstr Surg 1987;79(5):769–75.
Gilbert A. Reconstruction of congenital hand defects with microvascular toe transfers. Hand Clin 1985;1(2):351–60.
Serletti JM, Schingo JV Jr, Deuber MA, Carras AJ, Herrera HR, Reale VF. Free tissue transfer in pediatric patients. Ann Plast Surg 1996;36(6):561–8.
Yucel A, Aydin Y, Yazar S, Altintas F, Senyuva C. Elective free-tissue transfer in pediatric patients. J Reconstr Microsurg 2001;17(1):27–36.
Pinder RM, Hart A, Winterton RI, Yates A, Kay SP. Free tissue transfers in the first 2 years of life–A successful cost effective and humane option. J Plast Reconstr Aesthet Surg 2010;63(4):616–22.
Wilson RC, Yates AP. Paediatric microvascular surgery: anaesthetic experience of 27 toe to hand transfers. Pediatr Anesth 1993;3(4):209–15.
Chiang YC, Jeng SF, Yeh MC, Liu YT, Chen HT, Wei FC. Free tissue transfer for leg reconstruction in children. Br J Plast Surg 1997;50(5):335–42.
Moghari A, Emami A, Sheen R, O'Brien BM. Lower limb reconstruction in children using expanded free flaps. Br J Plast Surg 1989;42(6):649–52.
Canales F, Lineaweaver WC, Furnas H, Whitney TM, Siko PP, Alpert BS, et al. Microvascular tissue transfer in paediatric patients: analysis of 106 cases. Br J Plast Surg 1991;44(6):423–7.
Mast BA, Newton ED. Aggressive use of free flaps in children for burn scar contractures and other soft-tissue deficits. Ann Plast Surg 1996;36(6):569–75.
Horowitz JH, Nichter LS, Kenney JG, Morgan RF. Lawnmower injuries in children: lower extremity reconstruction. J Trauma 1985;25(12):1138–46.
Konttila E, Koljonen V, Kauhanen S, Kallio P, Tukiainen E. Microvascular reconstruction in children-a report of 46 cases. J Trauma 2010;68(3):548–52.
Yildirim S, Calikapan GT, Akoz T. Reconstructive microsurgery in pediatric population-a series of 25 patients. Microsurgery 2008;28(2):99–107.
Blackwell KE. Unsurpassed reliability of free flaps for head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1999;125(3):295–9.
El‐Gammal TA, El‐Sayed A, Kotb MM, Saleh WR, Ragheb YF, El‐Refai O, et al. Dorsal foot resurfacing using free anterolateral thigh (ALT) flap in children. Microsurgery 2013;33(4):259–64.
Acar MA, Güleç A, Aydin BK, Erkoçak ÖF, Yilmaz G, Şenaran H. Reconstruction of foot and ankle defects with a free anterolateral thigh flap in pediatric patients. J Reconstr Microsurg 2015;31(3):225–32.
Shenaq SM, Dinh TA. Pediatric microsurgery. Replantation, revascularization, and obstetric brachial plexus palsy. Clin Plast Surg 1990;17(1):77–83.
Duteille F, Lim A, Dautel G. Free flap coverage of upper and lower limb tissue defects in children: a series of 22 patients. Ann Plast Surg 2003;50(4):344–9.
Lickstein LH, Bentz ML. Reconstruction of pediatric foot and ankle trauma. J Craniofac Surg 2003;14(4):559–65.
Rinker B, Valerio IL, Stewart DH, Pu LL, Vasconez HC. Microvascular free flap reconstruction in pediatric lower extremity trauma: a 10-year review. Plast Reconstr Surg 2005;115(6):1618–24.
Lin CH, Mardini S, Wei FC, Lin YT, Chen CT. Free flap reconstruction of foot and ankle defects in pediatric patients: long-term outcome in 91 cases. Plast Reconstr Surg 2006;117(7):2478–87.