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Bustamante A, Zavala A, Iglesias M, Tornero R, Machaca L, De Pawlikowski W. Quality of Life After Lower Leg Reconstruction With the Latissimus Dorsi Free Flap in Pediatric Patients. Ann Plast Surg 2024; 92:418-423. [PMID: 38527349 DOI: 10.1097/sap.0000000000003812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND The latissimus dorsi free flap is a widely used reconstructive technique for complex lower leg defects in the pediatric population due to its reliability and anatomical features. However, the impact of this technique on the postoperative quality of life in children and adolescents, who require appropriate lower extremity function during their developmental period, remains to be analyzed. METHODS Patients who underwent microsurgical lower leg reconstruction using the latissimus dorsi flap were analyzed retrospectively. The quality of life of these patients was assessed prospectively using the Lower Extremity Functional Scale (LEFS) at a minimum of 18 months after surgical reconstruction. RESULTS Sixteen pediatric patients who had severe lower extremity injuries and underwent latissimus dorsi free flap reconstruction met the inclusion criteria. The mean follow-up period was 33.9 months (22-64 months). Two patients experienced postoperative complications: one had partial flap necrosis and surgical site infection, while the other developed a surgical site infection. The LEFS scores ranged from 26 to 80, with a mean score of 64.6. Remarkably, 14 of 16 patients achieved LEFS scores consistent with at least the 10th percentile when compared with normative data. Patients with severe associated fractures presented with the lowest scores. CONCLUSIONS Based on our findings, the latissimus dorsi flap is reaffirmed to be an excellent choice for lower leg reconstruction in the pediatric population. It effectively restores the quality of life in patients who have experienced moderate to severe lower extremity injuries.
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Affiliation(s)
- Atenas Bustamante
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Abraham Zavala
- Department of Plastic and Reconstructive Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Martin Iglesias
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Ray Tornero
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Lucero Machaca
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Wieslawa De Pawlikowski
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
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Blanco MD, de la Torre M, Lorca C, Del Cañizo A, Bada I, Monje S, García-Casillas MA, Villa Á, de Tomás E, Berenguer B. Use of pedicled flaps after oncologic resections in pediatric patients. Pediatr Surg Int 2024; 40:64. [PMID: 38433161 DOI: 10.1007/s00383-024-05654-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
The aim of this study is to review the indications of pedicled flaps and analyze the results. A observational retrospective study of under 18-year-old oncology patients who required reconstructive surgery with pedicled flaps between 2011 and 2022 was performed. Demographic and clinical variables, indications, complications, and outcomes were collected. 236 patients were reviewed and 13 met inclusion criteria, eight girls and five boys (mean age: 10.6 years). Indications were Ewing's sarcoma (5), osteosarcoma (5), neuroblastoma, desmoid tumor, and neurofibroma. Preoperative PET-CT, MRI and bone scintigraphy were performed. The flaps were used on costal and extremity reconstruction: latissimus dorsi (5), pectoralis (2), medial gastrocnemius (2), combined latissimus dorsi, trapezius and serratus muscle, biceps femoris, fascio-neuro-cutaneous saphenous and cutaneous advancement-rotation. Two were performed on allograft and eight on prosthesis. All allowed immediate and complete closure. Six patients received intraoperative radiotherapy. One flap infection and two vascular complications were reported, a total necrosis, which required a new flap, and a partial necrosis, treated with a local plasty. Chemotherapy was resumed after 21 days (15-31). Mean follow-up time was 5.34 years. Flaps are an effective therapeutic option allowing reconstruction of large defects after pediatric oncologic surgeries. The most frequent complication was vascular.
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Affiliation(s)
- María Dolores Blanco
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Department of Pediatric Surgery, Hospital Materno Infantil Gregorio Marañón, C/O'Donnell, 48, 28009, Madrid, Spain.
| | - Manuel de la Torre
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Lorca
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Agustín Del Cañizo
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Bada
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Monje
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ángel Villa
- Pediatric Traumatology Department Hospital General, Universitario Gregorio Marañón, Madrid, Spain
| | - Elena de Tomás
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Beatriz Berenguer
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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3
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Burns HR, Skochdopole AJ, Alfaro Zeledon R, Pederson WC. Pediatric Microsurgery and Free-Tissue Transfer. Semin Plast Surg 2023; 37:231-239. [PMID: 38098684 PMCID: PMC10718656 DOI: 10.1055/s-0043-1776698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Advancements in microsurgery, along with increased microsurgical experience in pediatric patients, have made free-tissue transfer a reliable modality for pediatric bone and soft tissue reconstruction today. Free-tissue transfer is most commonly used in children for the coverage of large or complex defects resulting from traumatic, oncologic, or congenital etiologies. While flap success and complication rates between pediatric and adult populations are similar, special considerations must be taken into account within the pediatric population. In this article, we will describe common indications, technical nuances, and clinical considerations for the management of the pediatric free-tissue transfer patient.
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Affiliation(s)
- Heather R. Burns
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Anna J. Skochdopole
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Richardo Alfaro Zeledon
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - William C. Pederson
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
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Soto E, Peacock PW, Clark AR, King TW, de la Torre JI, Patcha P, Fix RJ, Myers RP. A Systematic Review of Microsurgical Pedicle Lengthening in Free Tissue Transfer. Ann Plast Surg 2023; 90:S379-S386. [PMID: 37332209 DOI: 10.1097/sap.0000000000003450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Traumatic injuries that require free tissue flaps for reconstruction may require vascular pedicle extension between the flap and recipient vessels to form a clear anastomosis. Currently, a variety of techniques are used, each with their own potential benefits and harms. In addition, reports in the literature conflict on the reliability of pedicle extensions of vessels in free flap (FF) surgery. The objective of this study is to systematically assess the available literature about outcomes of pedicle extensions in FF reconstruction. METHODS A comprehensive search was performed for relevant studies published up to January 2020. Study quality was assessed using the Cochrane Collaboration risk of bias assessment tool and a set of predetermined parameters was extracted by 2 investigators independently for further analysis. The literature review yielded 49 studies investigating pedicled extension of FF. Studies meeting inclusion criteria underwent data extraction focusing on demographics, conduit type, microsurgical technique, and postoperative outcomes. RESULTS The search yielded 22 retrospective studies totaling 855 procedures from 2007 to 2018 in which 159 complications (17.1%) were reported in patients aged between 39 and 78 years. Overall heterogeneity of articles included in this study was high. Free flap failure and thrombosis were the 2 most prevalent major complications noted: vein graft extension technique had the highest rate of flap failure (11%) in comparison with the arterial graft (9%) and arteriovenous loops (8%). Arteriovenous loops had a rate of thrombosis of 5% versus 6% in arterial grafts and 8% in venous grafts. Bone flaps maintained the highest overall complication rates per tissue type at 21%. The overall success rate of pedicle extensions in FFs was 91%. Arteriovenous loop extension resulted in a 63% decrease in the odds of vascular thrombosis and a 27% decrease in the odds of FF failure when compared with venous graft extensions (P < 0.05). Arterial graft extension resulted in a 25% decrease in the odds of venous thrombosis and a 19% decrease in the odds of FF failure when compared with venous graft extensions (P < 0.05). CONCLUSIONS This systematic review strongly suggests that pedicle extensions of the FF in a high-risk complex setting are a practical and effective option. There may be a benefit to using arterial versus venous conduits, although further examination is warranted given the small number of reconstructions reported in the literature.
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Affiliation(s)
| | | | | | - Timothy W King
- Division of Plastic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jorge I de la Torre
- Division of Plastic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Prasanth Patcha
- Division of Plastic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - R Jobe Fix
- Division of Plastic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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Kondra K, Roohani I, Carey JN. Outcomes of Local Versus Free Flaps for Reconstruction of the Proximal One-Third of the Leg. Ann Plast Surg 2023; 90:S268-S273. [PMID: 37227407 DOI: 10.1097/sap.0000000000003465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Reconstruction of the proximal one-third of the leg often requires soft tissue transfer to facilitate limb salvage. Tissue transfers are usually local or free flaps depending on wound dimensions, location, and surgeon preference. Historically, the proximal third of the leg was covered with pedicle flaps, but recently, we have used more free flaps in this position. Using data from a level 1 trauma center, we sought to evaluate outcomes of surgical management of proximal-third leg reconstruction across local and free flaps. METHODS This is an institutional review board-approved, retrospective chart review undertaken at LAC + USC Medical Center from 2007 to 2021. Patient history, demographics, flap characteristics, Gustilo-Anderson fracture classification, and outcomes were collected and analyzed in an internal database. Outcomes of interest included flap failure rates, postoperative complications, and long-term ambulatory status. RESULTS Among 394 lower extremity flaps placed, 122 flaps involved the proximal-third leg across 102 patients. Average age of patients was 42.8 ± 15.2 years; of note, the free flap cohort was significantly younger than the local flap cohort (P = 0.019). Ten local flaps suffered from infectious complications: osteomyelitis (n = 6) and hardware infection (n = 4), versus only 1 free flap that suffered from hardware infection; notably, these differences were not significant across cohorts. Free flaps had significantly more flap revisions (13.3%; P = 0.039) and overall flap complications (20.0%; P = 0.031) compared with local flaps; however, partial flap necrosis (4.9%) and flap loss (3.3%) were not significantly different across cohorts. Overall flap survival was 96.7%, and full ambulation was achieved in 42.2% of patients without significant differences across cohorts. CONCLUSIONS Our evaluation of proximal-third leg wounds demonstrates fewer infectious outcomes with free flaps compared with local flaps. There are multiple confounding variables; however, this finding may speak to the reliability of a robust free flap. Overall, there was no significant difference in patient comorbidities across flap cohorts with great overall flap survival. Ultimately, flap selection did not affect rates of flap necrosis, flap loss, or final ambulatory status.
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Affiliation(s)
- Katelyn Kondra
- From the Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA
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Ibrahim AE, Ghieh FM, Oneisi AK, Atiyeh BS, Bassil GF, Otayek JN, Kortbawi RR, Moucharafieh RS. Expanding horizons of reconstructive microsurgery in Lebanon: Reconstruction of complex traumatic wounds with anterolateral thigh perforator flaps in paediatrics patients less than 10 years of age. Int Wound J 2023. [PMID: 36811264 DOI: 10.1111/iwj.14073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 02/24/2023] Open
Abstract
Paediatric complex wounds pose a challenge to the reconstructive surgeon due to the intricacy of reconstructive options required. Developments in microsurgery and microsurgical technique have brought free tissue transfer ever closer to the comfort zone of the reconstructive surgeon for reconstruction of paediatric traumatic complex wounds. We present our experience of microsurgical reconstruction in Lebanon for complex traumatic wounds in paediatric patients under the age of 10 years using the free anterolateral thigh (ALT) flap. The ALT flap has proven its value as a safe, adaptable, and aesthetically acceptable reconstructive option in paediatric complex trauma.
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Affiliation(s)
- Amir E Ibrahim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi M Ghieh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad K Oneisi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bishara S Atiyeh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Joeffroy N Otayek
- Department of Orthopedics, Lebanese American University, Beirut, Lebanon
| | - Rabih R Kortbawi
- Department of Orthopedics, St Georges University Medical Center, Beirut, Lebanon
| | - Ramzi S Moucharafieh
- Department of Orthopedics, St Georges University Medical Center, Beirut, Lebanon
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Catena N, Baldrighi C, Jester A, Soldado F, Farr S. Microsurgery in pediatric upper limb reconstructions: An overview. J Child Orthop 2022; 16:241-255. [PMID: 35992521 PMCID: PMC9382710 DOI: 10.1177/18632521221106390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023] Open
Abstract
The use of microsurgery has spread during the last decades, making resolvable many complex defects considered hitherto inapproachable. Although the small vessel diameter in children was initially considered a technical limitation, the increase in microsurgical expertise over the past three decades allowed us to manage many pediatric conditions by means of free tissue transfers. Pediatric microsurgery has been shown to be feasible, gaining a prominent place in the treatment of children affected by limb malformations, tumors, nerve injuries, and post-traumatic defects. The aim of this current concepts review is to describe the more frequent pediatric upper limb conditions in which the use of microsurgical reconstructions should be considered in the range of treatment options.
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Affiliation(s)
- Nunzio Catena
- Reconstructive Surgery and Hand Surgery
Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy,Nunzio Catena, Reconstructive Surgery and
Hand Surgery Unit, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini 5, 16121
Genova, Italy.
| | - Carla Baldrighi
- Children’s Hand and Upper Limb Service,
Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust,
Birmingham, UK
| | - Andrea Jester
- Children’s Hand and Upper Limb Service,
Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust,
Birmingham, UK
| | - Francisco Soldado
- Pediatric Hand, Nerve and Microsurgery
Institute, Vall d’Hebron Instituto de Oncologia, Barcelona, Spain
| | - Sebastian Farr
- Pediatric Orthopedics and Foot and
Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
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8
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Iamaguchi RB, Cartolano R, Silva GB, Torres LR, Cho AB, Wei TH, de Rezende MR, Mattar R. Orthoplastic reconstruction in children: are the risk factors similar to those observed in adults? J Pediatr Orthop B 2022; 31:e227-e235. [PMID: 34285161 DOI: 10.1097/bpb.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Free flaps in the pediatric population are less common and when indicated the expectations to avoid amputation are high. The objective of this study is to describe indications and results of free flaps for limb reconstruction. Patients undergoing microsurgical free flaps in an orthopedic hospital were consecutively included in this cross-sectional study, from 2014 to 2020. Data regarding personal medical history, intraoperative microsurgical procedure and laboratory tests were collected. Patients under 18 years of age were included. Complications and free flap outcomes were observed during follow-up. This study included 23 free flaps in 23 patients with orthoplastic reconstruction. The free flap was performed as a reconstructive elevator concept. The most common indications were skin or bone defects caused by trauma (nine patients), tumor (six patients) and congenital pseudarthrosis of the tibia (four patients). The most indicated flap was a vascularized fibular flap in 10 patients, followed by an anterolateral thigh flap in 5 patients. Complications were observed in five patients. In total 93% of patients with inferior limb reconstruction walked at the final evaluation. Among risk factors studied, cases had a higher incidence of complications (P = 0.03) when only the superficial venous system was used. Free flaps in children are well-tolerated and indications are restricted to precise indications to provide alternatives to amputations and improve patient's function. We observed an increase in the incidence of complications when only superficial veins were used for free flap outflow in children.
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Affiliation(s)
- Raquel Bernardelli Iamaguchi
- Department of Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, University of Sao Paulo, São Paulo, Brazil
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Pignatti M, D'Arpa S, Roche N, Giorgini FA, Lusetti IL, Lorca-Garcia C, De Santis G, Berenguer B. Surgical treatment of pressure injuries in children: A multicentre experience. Wound Repair Regen 2021; 29:961-972. [PMID: 34473875 PMCID: PMC9293131 DOI: 10.1111/wrr.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/22/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
Pressure injuries (PI) are infrequent in paediatric patients, prevalence estimates ranging from 1.4% to 8.2%, and reaching values as high as 43.1% in critical care areas. They can be associated with congenital neurological or metabolic disorders that cause reduced mobility or require the need for medical devices. In children, most pressure injuries heal spontaneously. However, a small percentage of ulcers that is refractory to conservative management or is too severe at presentation (Stage 3 or 4) will be candidates for surgery. We retrospectively reviewed the clinical history of paediatric patients affected by pressure injuries from four European Plastic Surgery Centres. Information was collected from clinical and radiology records, and laboratory reports. An accurate search of the literature revealed only two articles reporting on the surgical treatment of pressure injuries in children. After debridement, we performed surgical coverage of the pressure injuries. We report here our experience with 18 children aged 1–17 years, affected by pressure injury Stages 3 and 4. They were successfully treated with pedicled (17 patients) or free flaps (1 patient). The injuries involved the sacrum (6/18 patients), lower limb (3/18 patients), thoracic spine (2/18 patients), ischium (3/18 patients, bilateral in one patient), temporal area (3/18 patients), hypogastrium (1/18 patients) and were associated to medical devices in three cases. Flaps were followed for a minimum of 19 months and up to 13 years. Only two patients developed true recurrences that were treated again surgically. Pressure injuries are infrequent in children and rarely need surgical treatment. Pedicled flaps have a high success rate. Recurrences, contrary to what is reported in the literature, were rare.
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Affiliation(s)
- Marco Pignatti
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola di Bologna, Bologna.,DIMES, University of Bologna, Palermo
| | - Salvatore D'Arpa
- Plastic and Reconstructive Surgery, La Maddalena Cancer Center, Palermo, Italy
| | - Nathalie Roche
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Federico A Giorgini
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola di Bologna, Bologna.,Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, Modena, Italy
| | - Irene Laura Lusetti
- Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, Modena, Italy
| | | | - Giorgio De Santis
- Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, Modena, Italy
| | - Beatriz Berenguer
- Pediatric Plastic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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10
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Parikh RP, Ha A, Tung T. Free Flap Reconstruction of Traumatic Pediatric Foot and Ankle Defects: An Analysis of Clinical and Functional Outcomes. J Reconstr Microsurg 2021; 37:783-790. [PMID: 33853128 DOI: 10.1055/s-0041-1727187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Traumatic lower extremity injuries involving the foot and ankle can have devastating consequences and represent a complex reconstructive challenge. To date, there are limited reports on microsurgical reconstruction for foot and ankle defects in children. This study aims to evaluate clinical and functional outcomes of free flaps for pediatric foot and ankle injuries. METHODS This is a retrospective review of patients undergoing free flaps for traumatic foot and ankle defects at a pediatric trauma center between 2000 and 2015. Patients with less than 5-year follow-up were excluded. Demographics, clinical characteristics, and postoperative outcomes were evaluated. RESULTS Thirty patients undergoing 30 flaps were analyzed. The mean age was 11.9 years (range: 2 to 17 years). Muscle flaps (n = 21, 70%) were more common than fasciocutaneous flaps (n = 9, 30%). Limb salvage with functional ambulation was achieved in 96.7% of patients (n = 29). The complication rate was 33.3% (n = 10), with wound breakdown (n = 6, 20.0%) as most common feature. There were no significant differences in limb salvage, total or partial flap loss, fracture union, and donor-site complications based on flap type. Fasciocutaneous flaps were more likely to require revision procedures for contour compared with muscle flaps (55.6 vs. 9.5%, p = 0.013). Mean follow-up was 8.5 years. CONCLUSION Microsurgical reconstruction of pediatric foot and ankle defects results in high rates of limb salvage. A defect- and patient-centered approach to reconstruction, emphasizing durable coverage and contour, is critical to facilitating ambulation and ensuring favorable long-term functional outcomes.
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Affiliation(s)
- Rajiv P Parikh
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.,Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, District of Columbia
| | - Austin Ha
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Thomas Tung
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
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11
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Thakkar M, Bednarz B. Systematic Review of Free Tissue Transfer Used in Pediatric Lower Extremity Injuries. EPLASTY 2021; 21:e2. [PMID: 33747336 PMCID: PMC7941145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Mehul Thakkar
- Department of Plastic and Reconstructive Surgery, St Mary's Hospital, London, United Kingdom
| | - Bartlomiej Bednarz
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Bristol, United Kingdom
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12
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Zhang W, Li X, Li X. A systematic review and meta-analysis of perforator flaps in plantar defects: Risk analysis of complications. Int Wound J 2021; 18:525-535. [PMID: 33675188 PMCID: PMC8273610 DOI: 10.1111/iwj.13552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/15/2021] [Indexed: 12/18/2022] Open
Abstract
The purpose of this study was to identify the risk factors for complications of perforator flaps in plantar reconstruction. A systematic review was performed by searching the PubMed, Cochrane Library, MEDLINE, and EMBASE databases from their inception date up to October 2020. Only studies on reconstructing plantar defects with perforator flaps were included, and specific data were required for each patient in the included studies. A total of 14 studies involving 111 flaps were identified and included in the meta‐analysis. Our meta‐analysis identified two risk factors for postoperative complications: flap size over 50 cm2 (risk ratio [RR] = 3.12; P = .02), diabetes mellitus foot (RR = 3.26; P = .03). No significant differences were found regarding heel defects (P = .34), single perforator (P = .57), age older than 60 years (P = .19), chronic aetiology (P = .13), trauma (P = .33), tumour resection (P = .60), ulcer (P = .84), and burn (P = .76). Although more high‐quality studies with adequate sample sizes are needed, this meta‐analysis indicated that flap size over 50 cm2 and diabetes mellitus foot were significant risk factors for postoperative complications of perforator flaps in plantar reconstruction.
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Affiliation(s)
- Wei Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinyi Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaojing Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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13
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Duteille F, Oillic J, Pouzet L, Perrot P, Hamel A, Dautel G. Management of loss of tissue substance in children's limbs. What are the salient peculiarities? A proposed algorithm. ANN CHIR PLAST ESTH 2020; 65:479-495. [PMID: 32891460 DOI: 10.1016/j.anplas.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/21/2020] [Indexed: 11/16/2022]
Abstract
Loss of tissue substance in children's limbs has the same etiologies and in many cases, the same severity as in adults' limbs, and the means placed at the disposal of a surgeon are likewise comparable. It may nonetheless prove difficult to strategically position the different treatment methods in a decision-making tree. After all, a child presents numerous peculiarities: high quality of vascularization (both microcirculation and macrocirculation), better ability to achieve nerve regeneration and durable bone consolidation and, last but not least, a pronouncedly superior overall functional prognosis. Moreover, a child's future needs to be taken into account ; it is not only cicatrization per se, but also the quality of healing that should dictate therapeutic choices, which will consequently be determined in view of avoiding functional disorders during the growth process. On the basis of their experience and following a review of the literature, the authors have assessed the interest of each relevant technique and drawn up a decision-making tree.
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Affiliation(s)
- F Duteille
- Plastic, reconstructive and esthetic surgery unit, burn treatment center, CHU of Nantes, Nantes, France.
| | - J Oillic
- Plastic, reconstructive and esthetic surgery unit, burn treatment center, CHU of Nantes, Nantes, France
| | - L Pouzet
- Plastic, reconstructive and esthetic surgery unit, burn treatment center, CHU of Nantes, Nantes, France
| | - P Perrot
- Plastic, reconstructive and esthetic surgery unit, burn treatment center, CHU of Nantes, Nantes, France
| | - A Hamel
- Pediatric surgery unit, CHU of Nantes, Nantes, France
| | - G Dautel
- Plastic and reconstructive surgery unit of the musculoskeletal system, CHU of Nancy, France
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Clinical outcome of latissimus dorsi reconstruction after wide resection of soft-tissue sarcoma. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1441-1446. [PMID: 32583166 DOI: 10.1007/s00590-020-02723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND We investigated the clinical outcomes of reconstruction using the latissimus dorsi (LD) flap after resection of soft-tissue sarcoma. MATERIALS AND METHODS We analyzed 19 patients. Free LD flap was performed in 11 patients and pedicle flap in eight patients. The mean follow-up period after the surgery was 60 months. RESULTS The mean age at diagnosis was 57 years. The mean tumor size was 9.8 cm. The median size of the LD flap was 140 × 100 mm. The mean surgical duration and bleeding were 510 min and 602 mL, respectively. Complications included partial skin and soft-tissue necrosis (n = 3) and wound dehiscence (n = 2). No additional free flap was not necessary for the closure of the defect due to the complications. The longer surgical duration was significantly associated with wound complications (P = 0.048). The 5-year survival rate was 80.7%, and the local recurrence-free survival rate was 89.2%. Two patients developed local recurrence, while 6 patients developed metastasis. None of the patients had any restrictions of daily life. CONCLUSION The LD flap after surgical tumor resection in patients with soft-tissue sarcoma was useful for the coverage of soft tissue.
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