Free Tissue Transfer and Replantation in Pediatric Patients: Technical Feasibility and Outcome in a Series of 28 Patients

Abstract

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.

Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival?

“…On the other hand, still other studies have suggested that pediatric vessels are not prone to vasospasm . Aboelatta and Aly reported that patients 5 to 10 years of age present greater challenges in terms of surgical technique; patients under 5 years have more problems with flap outcomes; and patients over 10 years can undergo microsurgical procedures similar to adults. Serletti et al reported that vessel characteristics of children between 13 and 17 years of age are closer to those of adults.…”

“…Recently, the use of microsurgery for free flap transfer is commonly used in head and neck reconstructions at many centers . Although free flap transfer in pediatric patients presents many challenges, there have been many series published in the past 20 years demonstrating the safety and reliability of free flap transfer in such patients and its increasing use in head and neck reconstruction …”

“…Recently, the use of microsurgery for free flap transfer is commonly used in head and neck reconstructions at many centers. [1][2][3] Although free flap transfer in pediatric patients presents many challenges, there have been many series published in the past 20 years demonstrating the safety and reliability of free flap transfer in such patients [4][5][6][7][8][9][10][11][12][13][14][15][16][17] and its increasing use in head and neck reconstruction. 4,5,8,9,[17][18][19][20][21][22][23][24][25] Although high success rates (range 90%-99%) 4,5,8,9,[17][18][19][20][21][22][23][24][25] have been reported for free flap transfers in pediatric head and neck reconstruction, few studies have investigated factors affecting free flap survival.…”

Reconstrucción Microquirúrgica en El Trauma Pediátrico

“…La transferencia libre de tejido en niños, usualmente no presenta los factores de riesgo que sí enfrentamos en los adultos como son: el tabaquismo, y la enfermedad vascular periférica lo que por sí solo debe traducirse en una mejor posibilidad de éxito en este grupo, si sumado a esto, cuidamos los aspectos antes mencionados en relación al manejo de los vasos, no debiera asombrarnos las buenas cifras de éxito publicadas internacionalmente 14,15 . Sin embargo, hay temas que merecen una consideración especial y aún no han sido totalmente analizados: el efecto del crecimiento y desarrollo en el tejido trasplantado, así como las repercusiones psicológicas secundarias y la discapacidad a tan temprana edad de la zona dadora 16 .…”

Free Tissue Transfer in Pediatric Lower Limb Trauma

“…The accompanying vein or veins are used for the flap drainage as a rule; a few authors recommend adding the great saphenous vein for venous drainage; in 6 of 25 ALT flaps, anastomosis to the great saphenous vein as the second venous drainage was done. 17 22 The practice of performing two venous anastomosis seems to be not standard; certainly, the latissimus dorsi and the rectus abdominis afford the scope of a single venous anastomosis, 23 whereas with most ALT flaps 2 anastomosis could be done.…”