Microsurgery in the pediatric population is still challenging because of technical difficulties in the small vessel diameter anastomosis and flaps dissection. The present study reports our experience of microsurgical reconstruction with free tissue transfer and replantation. Twenty-eight pediatric patients under the age of 15 years underwent different microsurgical procedures over a 10-year period. Twenty-one patients (75 %) underwent elective free tissue transfer, while emergency replantation was done in seven patients (25 %). The overall successful microsurgical procedures were 25/28 (89 %). All the 21 free tissue transfers survived (100 %), while three of the seven emergency replantations were lost (57 % survival rate) in this group. Microvascular surgery in children is a feasible, safe, and reliable modality with high survival rate. The indications, success, failure, and complication rates are very near to adults. Over the age of 10 years, procedure is nearly similar to adults. Between the age of 5 and 10 years, successful outcome can be achieved also but with greater challenges in surgical technique. Below the age of 5 years, more challenges could be problematic for successful outcome. Experienced surgical team remains one of the most important factors to obtain good results. Knowledge of multiple reconstructive options and mastering one of them seems essential for satisfactory results.
Objective: Wound approximation device is an interesting reconstructive option but not well popularised. In this study we present a simple device that can be used for immediate or delayed closure of large dermal wounds in different anatomical areas. Method: Patients with acute and chronic wounds were recruited and underwent immediate intra-operative wound approximation and/or delayed wound approximation, with a home-made wound approximation device. Results: Approximation time in the immediate closure group ranged from 20–140 minutes. Satisfactory scars were obtained in 19 patients (76%) and adherent scars developed in 6 patients. Delayed wound approximation was used successfully in closure of 9 defects. Conclusion: This simple dermal wound approximation device can be used intraoperatively to successfully close large difficult wounds, located on the trunk and thigh, with minimal complications. The device can also be used to approximate delayed wounds located in regions where closure is particularly problematic, like the lower leg, foot, and scalp. Some modifications of the device are needed to improve its safety and efficacy. Wound tension is detrimental to adequate wound healing and tensile strength, another basic principle that should not be overlooked to avoid wound dehiscence. Wound approximation is adding to reconstructive options, not replacing them, and they must always be considered.
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