Free Tissue Transfer and Replantation in Pediatric Patients: Technical Feasibility and Outcome in a Series of 28 Patients
Tóm tắt
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.
Tài liệu tham khảo
Devaraj VS, Kay SP, Batchelor AG, Yates A (1991) Microvascular surgery in children. British J Plastic Surg 44:276–280
Malt RA, McKhann CF (1964) Replantation of several arms. J Am Med Assoc 189:716
Harii K, Ohmori K (1975) Free groin flaps in children. Plast Reconstr Surg 55:588
Ohmori K, Harii K, Sekiguchi J, Torii S (1977) The youngest free groin flap yet? British J Plastic Surg 30:273
Van Beek AL, Wavak PW, Zook EG (1979) Microvascular surgery in young children. Plast Reconstr Surg 63:457
Irons GB, Verheyden CN, Peterson HA (1982) Experience with the ipsilateral thigh flap for closure of heel defects in children. Plast Reconstr Surg 70:561
Iwaya T, Harii K, Yamada A (1982) Microvascular free flaps for the treatment of avulsion injuries of the feet in children. JTrauma Acute Care Surg 22:15
Furnas DW, Turpin IM, Bernstein JM (1983) Free flaps in young and old patients. Clin Plast Surg 10(1):149–154
Harii K (1984) Composite tissue transplantation of the upper extremity in children. In: Serafin D, Georaiade NG (eds) Pediatric plastic surgery. Mosby, St. Louis, p 1105
Serafin DO, Goodkhd DJ, Brewer B (1984) Soft tissue reconstruction of the lower extremity in children. In: Serafin D, Georgiade NG (eds) Pediatric plastic surgery. Mosby, St. Louis, p 1229
Serafin D, Bunvlck WI (1984) Microsurgical composite transplantation in children. In: Serafin D, Georgiade NG (eds) Pediatric plastic surgery. Mosby, St Louis, p 155
Canales F, Lineaweaver WC, Furnas H, Whitney TM, Siko PP, Alpert BS, Buncke GM, Buncke HJ (1991) Microvascular tissue transfer in pediatric patients: analysis of 106 patients. Br J Plast Surg 44:423–421
Upton J, Guo L (2008) Pediatric free tissue transfer: a 29-year experience with 433 transfers. Plast Reconstr Surg 121(5):1725–37
Duteille F, Lim A, Dautel G (2003) Free flap coverage of upper and lower limb tissue defects in children: a series of 22 patients. Ann Plast Surg 50:344–349
Chiang YC, Jeng SF, Yeh MC, Liu YT, Chen HT, Wei FC (1997) Free tissue transfer for leg reconstruction in children. Br J Plast Surg 50:335–342
Yazar S, Wei FC, Cheng MH, Huang WC, Chuang D, Lin CH (2008) Safety and reliability of microsurgical free tissue transfers in pediatric head and neck reconstruction—a report of 72 cases. J Plast Reconstr & Aesthet Surg 61(7):767–771
Gilbert A (1985) Reconstruction of congenital hand defects with microvascular toe transfers. Hand Clin 1(2):351–60
Shapiro J, Akbarnia BA, Hanel DP (1989) Free tissue transfer in children. J Pediatr Orthop 9(5):590–595
Boyer MI, Mih AD (1998) Microvascular surgery in the reconstruction of congenital hand anomalies. Hand Clin 14(1):135–142
Parry SW, Toth BA, Elliott LF (1988) Microvascular free-tissue transfer in children. Plast Reconstr Surg 81(6):838–40
Organek AJ, Klebuc MJ, Zuker RM (2006) Indications and outcomes of free tissue transfer to the lower extremity in children: review. J Reconstr Microsurg 22:173–81
Clarke HM, Upton J, Zuker RM, Manktelow RT (1993) Pediatric free tissue transfer: an evaluation of 99 cases. Can J Surg 36:525–28
Banic A, Wulff K (1987) Latissimus dorsi free flaps for total repair of extensive lower leg injuries in children. Plast Reconstr Surg 79:769–775
Arnold DJ, Wax MK, Microvascular committee of the American Academy of Otolaryngology, Head and Neck Surgery (2007) Pediatric microvascular reconstruction: a report from the Microvascular Committee. Otolaryngol–Head Neck Surg 136:848–851
Pinder RM, Hart A, Winterton RIS, Yates A, Kay SPJ (2010) Free tissue transfers in the first 2 years of life—a successful cost effective and human option. J Plast Reconstr & Aesthet Surg 63:616–622
Lin CH, Mardini S, Wei FC, Lin YT, Chen CT (2006) Free flap reconstruction of foot and ankle defects in pediatric patients: long-term outcome in 91 patients. Plast Reconstr Surg 117(7):2478–2487
Whitney TM, Clapson JB, Buncke HJ (1989) Free tissue transplantation. In: Wei F-C (ed) Symposium on microsurgical reconstruction. Hampton, Norfolk (CT), pp 126–136
Van Landuyt K, Hamdi M, Blondeel P et al (2005) Free perforator flaps in children. Plast Reconstr Surg 116:159–69
Colen SR, Shaw WW, McCarthy JG (1986) Review of the morbidity of 300 free flap donor sites. Plast Reconstr Surg 77:948–53
Khouri R, Cooley B, Kunselman A et al (1998) A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 102(3):711–721
Rinker B, Valerio IL, Stewart DH, Pu LLQ, Vasconez HC (2005) Microvascular free flap reconstruction in pediatric lower extremity trauma: a 10-year review. Plast Reconstr Surg 115(6):1618–1624
Wilson R, Yates A (1993) Pediatric microvascular surgery: anaesthetic experience of 27 toe to hand transfers. Paediatr Anaesth 3:209–215
Yucel A, Aydin Y, Yazar S et al (2001) Elective free-tissue transfer in pediatric patients. J Reconstr Microsurg 17(1):27–36
Serletti JM (2005) Current trends in pediatric microsurgery. Clin Plast Surg 32:45–52
Kim JY, Brown RJ, Jones NF (2005) Pediatric upper extremity replantation. Clin Plast Surg 32:1–10
Khouri RK (1992) Avoiding free flap failure. Clin Plast Surg 19:773–81