[Pediatric lower extremity reconstruction]

Systematic Review of Free Tissue Transfer Used in Pediatric Lower Extremity Injuries

Aims: To analyze the recent literature regarding the different types of free tissue transfer used in pediatric lower-limb trauma, trends, flap success rates, and the anatomical location of reconstruction. Method: A search was conducted involving the MEDLINE database using the key words "Paediatric," "Pediatric," "Children," "Lower limb," "Lower extremity," "Leg," "Ankle," "Foot," "Free flap," "Flap," "Microsurgery," and "Free tissue transfer" in a 3-component search applying the Boolean operators "OR" and "AND." The search was condensed to articles published in the last 5 years. Results: In total, 240 studies were retrieved. Thirty-nine titles were selected and after reviewing the abstracts, 10 articles fit the inclusion and exclusion criteria. A total of 220 free flaps were used to reconstruct defects. Age range was between 2 and 17 years. Complete flap failure rate was 4.5% (n = 10). The anterolateral thigh perforator flap was the commonest flap used (n = 59), and the latissimus dorsi flap was the commonest muscle flap used (n = 51). Sixty-five percent of flaps were fasciocutaneous/perforator, while muscle flaps accounted for only 33% of flaps. The foot and ankle region accounted for 72% of defects. Conclusion: With evidence of improved success rates, free tissue transfer has become a popular choice in reconstruction of pediatric lower-limb trauma injuries. This study shows that perforator/fasciocutaneous flaps have recently become a more popular choice over muscle flaps. Overall, the success rate of free flaps in pediatric lower-limb trauma is high (95.5%) and comparable with the adult population.

Free flaps for lower limb soft tissue reconstruction in children: Systematic review

BACKGROUND

Since the first reports on microsurgery in children, there has been an evolution in the reconstruction of soft tissue defects as evidenced by a shift to free flaps as the first-line treatment.

METHODS

The primary objective of this systematic review was to compare the complication rate of free perforator/fasciocutaneous flaps with free muscular/myocutaneous flaps in pediatric lower limb soft tissue reconstructions. The secondary objective was to evaluate the frequency and severity of complications for both reconstructive options. A search was performed in the databases PubMed, Web of Science, Embase, Scopus, and Cochrane Library depending on predefined inclusion criteria.

RESULTS

The evolution to perforator flaps from muscular and myocutaneous flaps is reflected in this systematic review as demonstrated by the anterolateral thigh (ALT) flap, which is the most common reconstructive option with a very low complication rate (11.3%) and flap loss. The latissimus dorsi (LD) flap was the second most frequently reported reconstruction with a complication rate comparable with that of the thoracodorsal artery perforator (TDAP) flap (32% vs. 39%, respectively), but the former suffers few failures. The radial forearm (RFA) fasciocutaneous flap can be considered a good alternative for ALT and TDAP flaps with a very low complication rate (16%) and no flap loss.

CONCLUSIONS

The ALT flap is considered the best reconstructive method for pediatric lower limb soft tissue defects. More adequate prospective studies specifically concerning free flap reconstructions for lower limb defects in children are necessary in the future to provide guidelines for treatment and optimize outcomes in the long term.