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Lam T, Levi E, Shen J, Wilks D, Alexander W. Radial forearm free flap reconstruction in a 3-month-old patient with undifferentiated pharyngeal sarcoma. Microsurgery 2024; 44:e31149. [PMID: 38363100 DOI: 10.1002/micr.31149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/01/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024]
Abstract
There is minimal information regarding free tissue transfers in very young infants, especially those less than a year old. It is often thought that that age remains a limit to free tissue transfers, with younger patients having smaller vessels, making the operation technically challenging. In this case report, we discuss the youngest and smallest recorded case of a free flap reconstruction. A 3-month-old patient with a malignant parapharyngeal undifferentiated round cell sarcoma underwent a resection and reconstruction with a radial forearm free flap (RFFF). The defect was 35 by 20 by 15 mm, and required a pharyngeal "patch," as opposed to a "tube," reconstruction. The defect was templated, and the RFFF then raised in a standard subfascial fashion, and inset with resorbable sutures. The patient was observed in the ICU postoperatively. The patient was subsequently diagnosed with Stage IV primary undifferentiated sarcoma with regional metastasis and received adjuvant chemotherapy. Fifteen-month follow up revealed no signs of recurrence, full oral intake, a well-reconstructed pharynx on nasoendoscopic examination, and minimal donor site morbidity. This report illustrates several unique adaptations of free flap transfer in infants and adds to the emerging body of evidence that age is not a contraindication for head and neck reconstruction.
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Affiliation(s)
- Theodore Lam
- Department of Plastics and Reconstructive Surgery, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Eric Levi
- Department of Otolaryngology, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Jacson Shen
- Department of Plastics and Reconstructive Surgery, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Daniel Wilks
- Department of Plastics and Reconstructive Surgery, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - William Alexander
- Department of Plastics and Reconstructive Surgery, The Royal Children's Hospital Melbourne, Melbourne, Australia
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Cohen Z, Plotsker E, Graziano F, Cordeiro P, Disa J, Mehrara B, Fabbri N, Azoury SC, Shahzad F. The evolution of pediatric soft-tissue free flap reconstruction of the lower extremity after oncologic resection: A 30 year experience. Microsurgery 2024; 44:e31130. [PMID: 37877296 PMCID: PMC11296888 DOI: 10.1002/micr.31130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Limb salvage has become the standard of care for lower extremity tumors because of improvements in adjuvant treatments and reconstructive techniques. While there is literature assessing pediatric lower extremity free flap reconstruction in the setting of trauma, there is a paucity of literature that analyzes oncologic free flap reconstruction in this patient population. We report our long-term experience and evolution of care for lower extremity oncologic free flap reconstruction in pediatric patients. METHODS This is a retrospective case series of all patients ≤18 years of age who underwent oncologic soft-tissue microvascular reconstruction of the lower extremity, from 1992 to 2021. Data were collected for patient demographics, oncologic treatment, operative details, and post-operative outcomes. Functional outcomes were assessed by weight bearing status, ambulation, and participation in activities-of-daily-living (ADLs), and musculoskeletal tumor society (MSTS) scores. RESULTS Over the 30-year study period, inclusion criteria were met by 19 patients (11 males, 8 females) with a mean age of 13.8 years and a mean follow-up of 5.3 years. At last follow-up, 13 patients (68.5%) were alive. The most common pathology was osteogenic sarcoma (13 patients, 68.5%). Sites of reconstruction were the hip (n = 1), thigh (n = 5), knee (n = 4), leg (n = 7), and the foot (n = 2). The most commonly used flaps were latissimus dorsi (n = 8), gracilis (n = 4), and anterolateral thigh ± vastus (n = 4). Postoperative complications occurred in nine patients (43%). Overall flap success rate was 95%. At latest follow-up, ambulation without assistive device was obtained in 11 patients (58%), full weight bearing was achieved by 13 patients (68.5%), and ADLs could be performed independently by 13 patients (68.5%). Mean MSTS score was 23.1/30. CONCLUSION Microvascular reconstruction for oncological lower extremity defects in the pediatric population has high limb salvage rates and good functional outcomes.
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Affiliation(s)
- Zack Cohen
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ethan Plotsker
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Francis Graziano
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter Cordeiro
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph Disa
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Babak Mehrara
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicola Fabbri
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Saïd C Azoury
- Division of Plastic Surgery, Department of Surgery University of Pennsylvania
- Department of Orthopedic Surgery, University of Pennsylvania
| | - Farooq Shahzad
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY
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Mundinger GS, Stalder MW, Lee J, Patterson CW, Sharma S, Womac DJ, Sopko NA, Swanson EW. Autologous Heterogeneous Skin Construct Closes Traumatic Lower Extremity Wounds in Pediatric Patients: A Retrospective Case Series. THE INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS 2023; 22:103-112. [PMID: 33686885 PMCID: PMC9902981 DOI: 10.1177/1534734621992284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Lower extremity traumatic wounds pose unique challenges in pediatric patients, including vessel caliber, compliance with postoperative instructions, parental concerns about multiple operations, and long-term function. An autologous heterogeneous skin construct (AHSC) has demonstrated the ability to cover avascular structures and regenerate full-thickness functional skin. The objective of this study is to report our experience using AHSC in a cohort of pediatric trauma patients. This study is a noncontrolled, retrospective cohort analysis of all pediatric patients (<19 years of age) treated with AHSC for lower extremity traumatic wounds with at least one exposed deep structure (tendon, bone, and/or joint) at a single institution between May 1, 2018, and April 1, 2019. Seven patients with 10 traumatic wounds met inclusion criteria. The median follow-up time was 11.8 months. Five patients were male (71%); the median age was 7 years (range = 2-15 years). Average wound size was 105 cm2. All wounds achieved coverage of exposed structures and epithelial closure in a median of 13 and 69 days, respectively. There were no donor site complications and no reoperations required. All patients returned to normal activity, ambulate without limp, can wear shoes normally, and have normal tendon gliding. AHSC covered exposed structures and achieved closure within a single application in complex traumatic lower extremity wounds in a pediatric cohort.
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Affiliation(s)
- Gerhard S. Mundinger
- Louisiana State University Health Sciences Center, New Orleans, LA, USA,Children’s Hospital of New Orleans, New Orleans, LA, USA,Gerhard S. Mundinger, Division of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center, 433 Bolivar Street, New Orleans, LA 70112-2784, USA.
| | - Mark W. Stalder
- Louisiana State University Health Sciences Center, New Orleans, LA, USA,Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - James Lee
- Tulane University, New Orleans, LA, USA
| | - Charles W. Patterson
- Louisiana State University Health Sciences Center, New Orleans, LA, USA,Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Silpa Sharma
- Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Daniel J. Womac
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
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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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"Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, With a Focus on Free Tissue Transfer.". Plast Reconstr Surg 2022; 150:406e-415e. [PMID: 35674517 DOI: 10.1097/prs.0000000000009325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Microsurgical free tissue transfer has been successfully implemented for various reconstructive applications in children. The goal of this study was to identify the best available evidence on perioperative management of pediatric patients undergoing free tissue transfer, and use it to develop evidence-based care guidelines. METHODS A systematic review was conducted in Pubmed, Embase, Scopus, and Cochrane Library databases. Since a preliminary search of the pediatric microsurgical literature yielded scant data with low level of evidence (LOE), pediatric anesthesia guidelines for healthy children undergoing major surgeries were also included. Exclusion criteria included: vague descriptions of perioperative care, case reports, and studies of syndromic or chronically ill children. RESULTS 204 articles were identified, and 53 met inclusion criteria. Management approaches specific to the pediatric population were used to formulate recommendations. High quality data was found for anesthesia, analgesia, fluid administration / blood transfusion, and anticoagulation (LOE 1). Lower quality evidence was identified for patient temperature (LOE 3) and vasodilator use (LOE 4). Key recommendations include: administering sevoflurane for general anesthesia, implementing a multimodal analgesia strategy, limiting preoperative fasting, restricting blood transfusions until hemoglobin < 7 g/dl unless patient is symptomatic, and reserving chemical venous thromboembolism prophylaxis for high risk patients. CONCLUSIONS Pediatric-specific guidelines are important as they acknowledge physiologic differences in children, which may be overlooked when extrapolating from adult studies. These evidence-based recommendations are a key first step toward standardization of perioperative care of pediatric patients undergoing plastic surgical procedures, including free tissue transfer, to improve outcomes and minimize complications.
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Knee Reconstruction following Sarcoma Resection Utilizing Pedicled Anterolateral Thigh Propeller Flap: A Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4107. [PMID: 35169531 PMCID: PMC8830920 DOI: 10.1097/gox.0000000000004107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
Coverage of knee wounds with exposure or violation of the joint capsule has long been a challenge to plastic surgeons. Wide resection and radiation treatment for soft-tissue sarcomas further this difficulty due to resultant diminished vascularity and soft tissue fibrosis. Traditional muscle flaps such as the gastrocnemius may be within the radiated field, limiting their arc of rotation to the knee. We present a series of exposed knee joint reconstructions using pedicled propeller flaps after sarcoma resection. Three patients diagnosed with soft tissue sarcomas underwent neoadjuvant radiation followed by wide local resection by orthopedic oncology. All patients had underlying knee joint exposure and underwent successful soft tissue reconstruction utilizing pedicled anterolateral thigh (ALT) propeller flaps. The ALT flap is widely used in plastic surgery for reconstruction of soft tissue defects due to its reliable vascularity, long pedicle, versatility, low donor-site morbidity, and large size. As a propeller flap, we demonstrate this is a viable alternative for reconstruction when the vascular plexus around the knee is unreliable after neoadjuvant radiation. Extending the ALT propeller flap with a large proximal skin paddle provides a nonmicrosurgical alternative to traditional muscle flaps at this location. The ALT propeller flap is an excellent option for reconstruction of large defects of the knee, especially in the setting of a radiated wound bed with unpredictable vascularity. In our case series, all three patients underwent successful reconstruction of exposed knee joints after resection of soft tissue sarcoma utilizing ALT propeller flaps.
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He J, Cui H, Qing L, Wu P, Guliyeva G, Yu F, Tang M, Tang J. Strategies for selecting perforator vessels for transverse and oblique DIEP flap in male pediatric patients: Anatomical study and clinical applications. Front Pediatr 2022; 10:978481. [PMID: 36210945 PMCID: PMC9542642 DOI: 10.3389/fped.2022.978481] [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: 06/26/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transverse and oblique deep inferior epigastric artery perforator (DIEP) flaps are widely used in breast, lower extremity, urogenital, head and neck reconstruction. In this report, we present our experience with selecting perforator vessels for transverse and oblique DIEP flaps based on an anatomical study and clinical cases. MATERIALS AND METHODS A detailed anatomical study of the DIEP flap was carried out using a standardized injection of lead oxide in 10 fresh cadavers. Additionally, 35 male pediatric patients (age 5-12 years) underwent lower extremity reconstruction with a DIEP flap. A transverse DIEP flap was used when the defect template did not exceed zone IV, while an oblique DIEP flap was used when the defect template exceeded zone IV. RESULTS Perforators located below the umbilicus in zones I and II were rich in transverse anastomoses across the midline of the abdominal wall, which is the basis for the transverse DIEP flap. Perforators lateral to the umbilicus in zone I had true anastomoses with the musculophrenic artery, the morphological basis for the oblique DIEP flap. The DIEP flap design was transverse in 20 patients and oblique in 15. Flap sizes ranged from 8 × 4.5 cm2 to 24 × 9 cm2. One oblique DIEP flap was necrosed totally, and it was repaired by a latissimus dorsi musculocutaneous flap. CONCLUSION The transverse DIEP flap design based on the perforator located below the umbilicus in zone I is recommended for small skin and soft tissue defects. We recommend the use of the oblique DIEP flap design based on the perforator lateral to the umbilicus in zone I as an extended flap to reconstruct large tissue defects.
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Affiliation(s)
- Jiqiang He
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huairui Cui
- Department of Anatomy, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Liming Qing
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Panfeng Wu
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Gunel Guliyeva
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Fang Yu
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Maolin Tang
- Department of Anatomy, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Juyu Tang
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China
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Li J, Xiong H, Li G, Zhou P, Ai F, Wang K, Chen J. Free Flap Reconstruction of Extremity Defects in Pediatric Patients. HANDCHIR MIKROCHIR P 2021; 53:349-355. [PMID: 34371519 DOI: 10.1055/a-1351-0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Microsurgical reconstruction of extremity defects with free flaps has been carried out for many years. The aim of this retrospective study is to characterize free flap surgery on children of 1 to 7 years old by evaluating a series of 20 cases of free flap surgeries that have been performed in pediatric patients. METHODS From February 2014 to January 2018, 20 patients, 10 boys and 10 girls aged from 1 to 7 years (average, 4.6 years), were engaged in this study. Several types of free flaps were used, including anterolateral thigh flaps (ALT), inferior ulnar collateral artery flap, latissimus dorsi flap, medial plantar flap, fibular osteocutaneous flap and hallux toenail flap. After operations, follow-up period was at least for 2 years and the average follow-up period was 48.5 months. The long-term outcomes were estimated by questionnaires derived from the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collection Instrument (PODCI). RESULTS A total of 21free-flap reconstructions were performed on 20patients, including 15 ALT, 3 composite flaps, and 3 other cutaneous flaps. The size of the tissue flap ranged from 1.5 to 280 cm2 (average, 74.1cm2). The diameter of the anastomosed artery of the flap ranged from 0.7 to 1.2 mm. Among the 21 flaps, 20 survived and the success rate was about 95 %. Contour adaption was achieved in all flaps. Fifteen children received a secondary operation for debulking or functional improvement. Secondary deformity was present in 3 children, among which ankle joint valgus was seen in two children and a flexion deformity of injured toe occurred in one child. The mean global functioning score of PODCI was 94 (ranging from 81 to 98, maximum 100). CONCLUSION The success rate of free-flap surgery in pediatric patients was comparable to that achieved in adults. Post-operative caring for pediatric patients was easier than expected. For pediatric patients, the final outcomes were not varied remarkably from different types of free tissue transfer.
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Klein C, Marie-Christine P, Deroussen F, Haraux E, Gouron R. Treatment options for soft tissue defects in severe foot trauma in children. J Wound Care 2021; 30:432-438. [PMID: 34121437 DOI: 10.12968/jowc.2021.30.6.432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Severe foot trauma in children is a therapeutic challenge, with presence of devitalised and soiled distal tissues. Several reconstruction and covering procedures can be applied, including artificial dermis (AD), negative pressure wound therapy (NPWT), fasciocutaneous flaps and free flaps. Here, we have developed and evaluated an algorithm for treating severe foot injuries with skin defects in children. METHOD Paediatric cases of severe foot injury treated over a 16-year period were retrospectively reviewed. Characteristics of the injuries, surgical procedures, complications and the modified Kitaoka score (clinical and functional rating score of the ankle and foot) were recorded. RESULTS A total of 18 children were included. The mean age at the time of injury was four years and 10 months (range: 1-11 years). The mean follow-up period was 6.2 years. Of the children, 13 presented with an amputation (12 partial foot amputations and one whole ankle and foot). The skin defect was combined with tendon exposure in nine cases, and/or bone and cartilage in seven cases, and heel damage in two cases. A flap was implemented in eight cases, of which one failed. NPWT was used in 13 patients (for an average of 21 days) and was combined with AD in six patients. The mean modified Kitaoka score was 68 (range: 55-80). Additional surgery during the follow-up period was required in seven patients (dorsal skin retraction, a thick flap, osteoma, trophic ulcer or ankle deviation). CONCLUSION Our algorithm suggests different therapeutic strategies for skin coverage and healing, depending on the size of the lesion and the exposed structures, and seems to offer good results. These procedures should be combined with NPWT to optimise these results (improved healing, reduced infections, decreased skin defects and enhanced granulation tissue) and so should be used more frequently.
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Affiliation(s)
- Céline Klein
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France
| | - Plancq Marie-Christine
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France
| | - François Deroussen
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France
| | - Elodie Haraux
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France
| | - Richard Gouron
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardie, Amiens, France
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Wagner RD, Yang JS, Bryant BE, Pederson WC, Izaddoost SA. Free latissimus dorsi flap for upper extremity reconstruction in a 9-month-old. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:105-109. [PMID: 34263010 PMCID: PMC8259861 DOI: 10.1080/23320885.2021.1947141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Successful outcomes for free tissue transfer are well-documented in pediatric patients but less so in infants. Challenges with infants are unique and include implications of prolonged anesthetic exposure. We present a 9-month-old female who underwent a free latissimus dorsi flap to reconstruct a congenital upper extremity lesion threatening limb development.
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Affiliation(s)
- Ryan D Wagner
- Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jacqueline S Yang
- Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Brittany E Bryant
- Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - William C Pederson
- Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Implications of Free Temporoparietal Fascial Flap Reconstruction in the Pediatric Population. J Craniofac Surg 2021; 32:1400-1404. [PMID: 33496524 DOI: 10.1097/scs.0000000000007467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The temporoparietal fascial flap (TPFF) is a versatile tool that can be used in the reconstruction of head and neck and distal upper and lower extremity defects. The TPFF may be harvested as a pedicle or free flap as well as with the temporalis muscle and/or adjacent calvarial bone as a composite flap. As a free flap, the TPFF has been used as a joint gliding surface with coverage of nerves and tendons, for extremity soft tissue repair, for tracheal and pharyngeal coverage and for defects of the nose, scalp, and auricle. This article focuses on the use of the free TPFF in the pediatric population through systemic review of the medical literature. Current perspectives on the use of this flap and microsurgery in general in pediatric patients are addressed.
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Mayo-Yáñez M, Rodríguez-Pérez E, Chiesa-Estomba CM, Calvo-Henríquez C, Rodríguez-Lorenzo A. Deep inferior epigastric artery perforator free flap in head and neck reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2020; 74:718-729. [PMID: 33334702 DOI: 10.1016/j.bjps.2020.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Perforator flaps yield the best results for the patient with the least morbidity, and they should be considered the gold standard in head and neck reconstruction. Although deep inferior epigastric perforator (DIEP) flap is considered as the gold standard in breast reconstruction, its use in head and neck reconstructive surgery does not seem so widespread. The objective of this study is to conduct a systematic review of the use, applications and results of the DIEP flap in the head and neck area. METHODS Search was conducted in different indexed databases (PubMed/MEDLINE, the Cochrane Library, Scielo and Web of Science) and through meta-searcher Trip Database with deep inferior epigastric perforator flap AND head neck keywords. Studies on animal and human experiments published in peer-reviewed journals, where investigators assessed the use of DIEP flap, according to the Koshima criteria, in the head and neck area were considered. RESULTS A total of 31 articles and 185 flaps with 95% of survival were found. Thrombosis or venous stasis is the most frequent cause of flap loss and 16.1% presented some type of complication, the most frequent being the dehiscence. The most use was in the reconstruction of glossectomy defect secondary to squamous cell carcinoma (30.51%), being able potentially to re-establish sensory innervation in oral cavity. The assessment of risk bias (National Institutes of Health) highlights the lack of uniformity, with no standardisation of the outcome variable collection and monitoring. DISCUSSION By virtue of its versatility, reliable vascular supply and high flap survival rate, the DIEP flap reconstruction could be an option in complicated 3-dimensional head and neck defects while maintaining the standard of low donor site morbidity.
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Affiliation(s)
- Miguel Mayo-Yáñez
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), As Xubias 84, 15006 A Coruña, Galicia, Spain; Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), 15782 Santiago de Compostela, Galicia, Spain; Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.
| | - Esther Rodríguez-Pérez
- Plastic, Aesthetic and Reconstructive Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Galicia, Spain
| | - Carlos Miguel Chiesa-Estomba
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France; Otorhinolaryngology - Head and Neck Surgery Department, Hospital Universitario Donostia, 20014 Donostia, Gipuzkoa, Spain
| | - Christian Calvo-Henríquez
- Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), 15782 Santiago de Compostela, Galicia, Spain; Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France; Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario Santiago de Compostela (CHUS), 15706 Santiago de Compostela, Galicia, Spain
| | - Andrés Rodríguez-Lorenzo
- Plastic and Maxillofacial Surgery Department, Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Surgical Sciences (IKV), Uppsala University, 751 05 Uppsala, Sweden
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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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Bulla A, Delgove A, De Luca L, Pelissier P, Casoli V. The esthetic outcome of lower limb reconstruction. ANN CHIR PLAST ESTH 2020; 65:655-666. [PMID: 32800462 DOI: 10.1016/j.anplas.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND In recent years, the progress of anatomical knowledge and microsurgical techniques, in particular the development of perforator flaps, has risen the number of flaps available for lower leg reconstruction. The esthetic consequences of flap choice and harvest do have an impact on patients' quality of life. Nowadays, more researchers evaluate the esthetic changes following lower limb reconstruction. OBJECTIVES This review aims to summarize the available evidence on the esthetic outcome of lower limb reconstruction. DATA SOURCES A systematic review was planned to identify the most relevant indexed articles on this subject. The search was performed on Pubmed database without date of publication limits. STUDY ELIGIBILITY CRITERIA All papers about reporting information about the esthetic outcome of lower limb reconstruction were selected. Case reports and the articles not including specific information about complications, secondary procedures, and outcomes were excluded. The articles were categorized according to their topic and date of publication. The full texts of all the articles were obtained and read thoroughly. The references for each article were screened to identify articles that were eventually left outside our database search. PARTICIPANTS, AND INTERVENTIONS One hundred and eight articles were retained for the definitive review. Eleven review articles were kept because they represented a good source of information. Thirty-three articles were added after reading the full texts. The articles appear highly heterogeneous and at, this stage, only a critical and qualitative analysis could be performed. RESULTS We found information about 7895 lower reconstructions, 1295 local flaps, 6546 free flaps. LIMITATIONS The esthetic evaluation is intrinsic subjective. Many psychological and cultural factors influence both the patient and the surgeon. There is not a validated assessment tool for the esthetic outcome of lower leg reconstruction. Therefore, no quantitative analysis was performed. CONCLUSIONS Some ancient techniques are today obsolete, like the rectus abdominis free muscle flaps and perhaps free forearm flap, others are always useful, like gracilis and latissimus dorsi free flap. ALT flap is the most versatile perforator flap today available, but the SCIP flap is gaining the favor of a growing number of surgeons. Local flaps will be always performed with success but their indications should not be pushed beyond the medium-size defects. The best cosmetic outcome for each patient cannot necessarily be obtained neither with the easiest techniques nor with the most technically demanding ones. It is necessary to develop validated tools to assess the cosmetic outcome of lower limb reconstruction.
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Affiliation(s)
- A Bulla
- Department of Plastic and Reconstructive Surgery, Hand Surgery, Burns Unit, F.X.-Michelet Center, University Hospital Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - A Delgove
- Department of Plastic and Reconstructive Surgery, Hand Surgery, Burns Unit, F.X.-Michelet Center, University Hospital Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - L De Luca
- Department of Plastic and Reconstructive Surgery, Hand Surgery, Burns Unit, F.X.-Michelet Center, University Hospital Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - P Pelissier
- Department of Plastic and Reconstructive Surgery, Hand Surgery, Burns Unit, F.X.-Michelet Center, University Hospital Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - V Casoli
- Department of Plastic and Reconstructive Surgery, Hand Surgery, Burns Unit, F.X.-Michelet Center, University Hospital Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Cao ZM, Du W, Qing LM, Zhou ZB, Wu PF, Yu F, Pan D, Xiao YB, Pang XY, Liu R, Tang JY. Reconstructive surgery for foot and ankle defects in pediatric patients: Comparison between anterolateral thigh perforator flaps and deep inferior epigastric perforator flaps. Injury 2019; 50:1489-1494. [PMID: 31300162 DOI: 10.1016/j.injury.2019.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUNDS Due to the delicate tissue, small blood vessels and incomplete development of interarticular ligaments, skin and soft-tissue defects of the foot and ankle in pediatric patients remain a challenge for orthopedic and plastic surgeons. Anterolateral thigh perforator (ALTP) flap and deep inferior epigastric perforator (DIEP) flap are the most commonly used flaps for the repair of lower-extremity soft-tissue defects. The literature contains a shortage of evidence involving the differences between ALTP and DIEP flaps in the reconstruction of young patients with complex foot and ankle defects. This study was designed to determine which type of flap is better for foot and ankle repair in pediatric patients. METHODS From January 2004 to January 2018, 79 children younger than 14 years treated with DIEP flap (41 cases) or ALTP flap (38 cases) for composite defects of the feet and ankles were retrospectively investigated. The two groups were homogeneous in terms of age, the location of the defect, etiology, and flap area. Complications, scarring, cosmetic appearance, flap sensory recovery, and functional outcome were analyzed, and statistical analysis was performed. RESULTS The ALTP group had shorter operation time (155.0 ± 12.0 min vs 212.2 ± 23.9 min), flap harvested time (39.6 ± 5.1 min vs 57.2 ± 10.4 min), and operative blood loss (143.4 ± 23.7 ml vs 170.7 ± 44.7 ml) than the DIEP group (P < 0.05). In short-term follow-up, ALTP group showed a lower flap necrosis rate (5.3% vs 24.4%) and vascular insufficiency rate (2.6% vs 19.5%) than DIEP group (P < 0.05). In long-term follow-up, ALTP group showed a lower late complication rate and better cosmetic, functional, scar outcomes than DIEP group (P < 0.05). CONCLUSIONS The study showed that an ALTP flap may brings better results than a DIEP flap in terms of short- and long-term complications, scarring, and morpho-functional outcomes for pediatric patients undergoing reconstruction of foot and ankle defects.
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Affiliation(s)
- Zhe-Ming Cao
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China
| | - Wei Du
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China; Department of Rehabilitation Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China
| | - Li-Ming Qing
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China
| | - Zheng-Bing Zhou
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China
| | - Pan-Feng Wu
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China
| | - Fang Yu
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China
| | - Ding Pan
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China
| | - Yong-Bing Xiao
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China
| | - Xiao-Yang Pang
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China
| | - Rui Liu
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China
| | - Ju-Yu Tang
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province, 410008, China.
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A Simple Skin Incision Design for Pediatric Superficial Branch of Superficial Circumflex Iliac Artery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2159. [PMID: 31321173 PMCID: PMC6554152 DOI: 10.1097/gox.0000000000002159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/03/2019] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Superficial circumflex iliac artery (SCIA) perforator flap is one of the demanding flaps. However, little is known about SCIA anatomy, which is crucial for successful SCIA perforator flap elevation, in children. We assessed the efficacy of our incision design to detect the superficial branch of the SCIA in vivo. Methods: Eleven consecutive pediatric patients who required harvesting (eg, skin grafts or vascularized lymph node transfer) were assessed. All possible congenital vascular malformation cases were excluded. To reduce potential bias, all groin procedures were performed on the contralateral side of malformations. After inguinal area mapping, 1.5-cm skin incision was made. From the window opened by the skin incision, tiny perforation to the skin surface was detected for further dissection. Following the tiny branch, the main trunk of the superficial circumflex vascular bundle was dissected. The whole vascular bundle, artery, and major vein from the bundle were dissected and their sizes were measured. Results: Of the 11 patients, 4 were boys; the age range was 5 months to 14 years (mean age: 3.2 years). Vessel bundle size was 0.7–1.5 (mean: 1.1 mm). In all cases, the bundle was detected within 5 min (1–5, mean: 2.5 min). No vascular damage was observed, and all arteries pulsated well, without requiring additional skin incision. The superficial branch of the SCIA was mainly detected right below the initial skin incision. Conclusions: Our skin incision design can effectively detect the SCIA in pediatric patients and may be used in adult patients.
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Khadim MF, Emam A, Wright TC, Chapman TWL, Khan U. A comparison between the Major Trauma Centre management of complex open lower limb fractures in children and the elderly. Injury 2019; 50:1376-1381. [PMID: 31128908 DOI: 10.1016/j.injury.2019.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Open lower limb fractures can be devastating with outcomes determined by tissue damage and adherence to strictly defined care pathways. Managing such injuries in paediatric and elderly populations presents logistical and technical challenges to achieve best outcomes. Orthoplastic principles were developed mainly in the young adult population whereas requirements for paediatric and elderly patients need further understanding. METHODS A retrospective analysis was performed on two groups of patients at the extremes of age, with type IIIb (severe) open lower limb fractures, presenting to a Major Trauma Centre (MTC) with orthoplastic services over a six-year period - the first group being under 16 years; the second group being over 65. The timelines of combined surgery to both fix the fracture and flap the soft-tissue defect were strictly observed. Each group were followed-up for a minimum of nine months. Data were analysed according to patient demographics, mechanism of trauma, time to wound excision, time to definitive surgery, fixation technique, soft-tissue reconstruction type, deep infection rate, flap survival, bony union, secondary amputation and functional outcome (Enneking score). RESULTS 33 paediatric patients and 99 elderly patients were identified. Paediatric: The median age was 12 years. All the children were ASA Grade I. Open tibial fractures were most common (76%) followed by ankle fracture dislocation (12%). The majority were high-energy injuries and were commonly managed with external fixators (or frames) and free flap coverage. Median hospital stay was 12 days, and time to union 114 days, with median Enneking scores of 85%. There was one flap failure and no deep infections. Elderly: The median age was 76 years. ASA grades varied and reflected multiple comorbidities. High-energy injuries required free flaps, while more common, low-energy fragility fractures were covered with loco-regional flaps. Internal fixation with intramedullary nails was most commonly used. Median hospital stay was 13 days, and time to union was 150 days, with median Enneking scores of 70%. There was one flap failure, one deep infection, and one delayed amputation. DISCUSSION These results reflect both similarities and important differences in managing open fractures in the extremes of age. The specific challenges of each group of patients are discussed, including surgical aspects, but also the importance of orthoplastics infrastructure within the MTC and input from allied professionals to facilitate patient pathways.
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Affiliation(s)
| | - Ahmed Emam
- Southmead Hospital, North Bristol NHS Trust, Southmead Road, Bristol BS10 5NB, UK
| | - Thomas C Wright
- Southmead Hospital, North Bristol NHS Trust, Southmead Road, Bristol BS10 5NB, UK
| | - Thomas W L Chapman
- Southmead Hospital, North Bristol NHS Trust, Southmead Road, Bristol BS10 5NB, UK
| | - Umraz Khan
- Southmead Hospital, North Bristol NHS Trust, Southmead Road, Bristol BS10 5NB, UK.
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Sui X, Cao Z, Pang X, He J, Wu P, Zhou Z, Yu F, Tang JY. Reconstruction of moderate-sized soft tissue defects in foot and ankle in children: Free deep inferior epigastric artery perforator flap versus circumflex scapular artery perforator flap. J Plast Reconstr Aesthet Surg 2019; 72:1494-1502. [PMID: 31221596 DOI: 10.1016/j.bjps.2019.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/24/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND This retrospective study was conducted to compare the outcomes between the free deep inferior epigastric artery perforator (DIEP) flap and the circumflex scapular artery perforator (CSAP) flap in reconstruction of moderate-sized soft tissue defects in the foot and ankle of pediatric patients. PATIENTS AND METHODS From January 2004 to December 2016, 42 patients, ranging from 2 to 13 years old, underwent foot and ankle reconstruction, with a free DIEP flap in 21 cases and a free CSAP flap in the other 21cases. RESULTS All the flaps survived. No marked differences were observed in the demographics, flap size, recipient vessels, and overall early or late complication rate (p > 0.05). The CSAP group had a shorter operation time (134.3 ± 25 min vs. 202.4 ± 24.3 min, p < 0.05) and flap harvest time (29.7 ± 8.1 min vs. 52.2 ± 9.8 min, p < 0.05) than the DIEP group had. In long-term follow-up, the CSAP group showed a lower fat hyperplasia rate (14% vs. 52%, p < 0.05) and better cosmetic outcomes than the DIEP group did (p < 0.05). The functional outcomes had no marked differences (p > 0.05). CONCLUSIONS The DIEP flap and the CSAP flap are both good options for foot and ankle reconstruction of moderate-sized defects in pediatric patients. The CSAP flap has a shorter operation time and flap harvest time, a lower fat hyperplasia rate, and better long-term cosmetic outcomes than the DIEP flap does.
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Affiliation(s)
- Xinlei Sui
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, No. 87 Xiang Ya Road, Changsha, Hunan 410008, China
| | - Zheming Cao
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, No. 87 Xiang Ya Road, Changsha, Hunan 410008, China
| | - Xiaoyang Pang
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, No. 87 Xiang Ya Road, Changsha, Hunan 410008, China
| | - Jiqiang He
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, No. 87 Xiang Ya Road, Changsha, Hunan 410008, China
| | - Panfeng Wu
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, No. 87 Xiang Ya Road, Changsha, Hunan 410008, China
| | - Zhengbing Zhou
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, No. 87 Xiang Ya Road, Changsha, Hunan 410008, China
| | - Fang Yu
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, No. 87 Xiang Ya Road, Changsha, Hunan 410008, China
| | - Ju-Yu Tang
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, No. 87 Xiang Ya Road, Changsha, Hunan 410008, China.
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Claes KE, Roche NA, Opsomer D, De Wolf EJ, Sommeling CE, Van Landuyt K. Free flaps for lower limb soft tissue reconstruction in children: Systematic review. J Plast Reconstr Aesthet Surg 2019; 72:711-728. [PMID: 30898501 DOI: 10.1016/j.bjps.2019.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Karel Ey Claes
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium.
| | - Nathalie A Roche
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Dries Opsomer
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Edward J De Wolf
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Casper E Sommeling
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Koenraad Van Landuyt
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
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Boyd LC, Bond GA, Hamidian Jahromi A, Kozusko SD, Kokkalis Z, Konofaos P. Microvascular reconstruction of pediatric lower extremity trauma using free tissue transfer. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:285-293. [DOI: 10.1007/s00590-019-02367-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/03/2019] [Indexed: 11/28/2022]
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Reconstruction of Large Soft Tissue Defects of the Extremities in Children Using the Kiss Deep Inferior Epigastric Artery Perforator Flap to Achieve Primary Closure of Donor Site. Ann Plast Surg 2019; 82:64-70. [DOI: 10.1097/sap.0000000000001659] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Free tissue transfer has become the standard in wound coverage and further refinements have given us newer flap donor sites or modifications of existing flaps to decrease morbidity; smaller vessels are being anastomosed, a direct spin-off following successful distal replantations. Younger children are presenting with traumatic defects similar to adults. Although there were apprehensions of free tissue transfer in children occasioned by smaller vessels, duration of procedure and concerns of growth following flap harvest, reports of small and large series have appeared in the literature with similar success. Pediatric-free tissue transfer is now an established entity. This article seeks to arrive at a consensus based on a review of the existing literature on free flaps for skin and soft-tissue coverage of lower limb trauma in children.
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Affiliation(s)
- R. Srikanth
- Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Free flaps for head and neck cancer in paediatric and neonatal patients. Curr Opin Otolaryngol Head Neck Surg 2018; 26:127-133. [PMID: 29369088 DOI: 10.1097/moo.0000000000000434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review recent literature on the subject of free tissue transfer options in paediatric head and neck surgery, with a particular emphasis on highlighting the advantages and disadvantages of different reconstructions in the paediatric patient. RECENT FINDINGS Free tissue transfer in paediatric patients is predictable and applicable for a wide range of congenital and acquired defects in the head and neck. The free fibula flap is a mainstay of mandibular reconstruction and allows excellent implant-supported prosthodontic rehabilitation and growth potential at the recipient site with little or no donor site morbidity. Other less commonly explored options include the deep circumflex iliac artery flap, scapula flap and medial femoral condyle flap. The gracilis mucle remains the mainstay for facial reanimation with other options including pectoralis minor, rectus abdominis, extensor digitorum brevis and latissimus dorsi. There are compelling arguments for centralization of services and creative strategies in postoperative rehabilitation (e.g. play therapy). SUMMARY Free flaps in paediatric patients are a viable option and may even have advantages relative to adults because of the absence of atherosclerosis, purported lower risk of vasospasm and proportionally larger vessel size. Transfer earlier in life maximizes functional potential and 'normalizes' treatment.
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Gelidan AG. Salvage of planned ALT flap with rectus femoris free flap for pediatric lower extremity reconstruction: A demonstrative case report. Int J Surg Case Rep 2018; 51:67-70. [PMID: 30144713 PMCID: PMC6108076 DOI: 10.1016/j.ijscr.2018.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/02/2018] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Free tissue transfer in children represents a good option for reconstruction in skilled hands despite the technical difficulties, and represent a significant challenge in microsurgery. With Anteriorlateral thigh flap is a popular option even in pediatric age group. PRESENTATION OF CASE We report here a case of 9 year old girl that sustained a lower extremity trauma with exposed ankle joint secondary to Motor Vehicle Crash, That was planned for (ALT) Anterior Lateral Thigh flap reconstruction, and was not completed and salvaged by rectus femoris flap as an alternative option on table to complete the reconstruction. DISCUSSION Such case was successfully reconstructed by rectus femoris muscle free flap when ALT (Anterior lateral thigh) flap could not be completed as planned although it's the workhorse flap in majority of cases, due to absence of perforator utilizing the same vascular anatomical blood supply with no significant donor site morbidity. CONCLUSION Based on this case report the rectus femoris flap was successfully performed, and we believe it's an effective and reliable backup option to reconstruct complex lower extremity wound even in pediatric age group.
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Affiliation(s)
- Adnan G Gelidan
- The Division of Plastic Surgery, King Saud University, P.O. Box 7805, Riyadh, 11462, Saudi Arabia.
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27
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Merter A, Armangil M, Kaya B, Bilgin S. Immediate emergency free anterolateral thigh flap after car-tyre friction injury: A case report with eight years follow-up. Int J Surg Case Rep 2017; 38:102-106. [PMID: 28755614 PMCID: PMC5537393 DOI: 10.1016/j.ijscr.2017.06.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/31/2017] [Accepted: 06/04/2017] [Indexed: 11/20/2022] Open
Abstract
The car-tyre friction injury has differences from other injuries. The components of injury which are burn, crushing, shearing, and degloving occur. Many treatment options can be performed for coverage of wound which are Vacuum Assisted Closure system (V.A.C), skin grafting, free flaps, local flaps and cross leg flap.
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Affiliation(s)
- Abdullah Merter
- Kahramanmaras Afsin State Hospital, Orthopedic Clinic, Turkey.
| | - Mehmet Armangil
- Ankara University, School of Medicine, Ibn-i Sina Hospital, Department of Orthopedics, Division of Hand Surgery, Turkey
| | - Burak Kaya
- Ankara University, School of Medicine, Cebeci Hospital, Department of Plastic and Reconstructive Surgery, Turkey
| | - Sinan Bilgin
- Ankara University, School of Medicine, Ibn-i Sina Hospital, Department of Orthopedics, Division of Hand Surgery, Turkey
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28
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Wang HD, Alonso-Escalante JC, Cho BH, DeJesus RA. Versatility of Free Cutaneous Flaps for Upper Extremity Soft Tissue Reconstruction. J Hand Microsurg 2017; 9:58-66. [PMID: 28867904 DOI: 10.1055/s-0037-1603918] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022] Open
Abstract
The goals of upper extremity soft tissue reconstruction should go well beyond providing coverage and restoring function. As the field of reconstructive microsurgery has evolved, free cutaneous flaps (FCFs) are gaining wider application. The advantages of FCF include minimizing donor-site morbidity by preserving the muscle and fascia, improving versatility of flap design, and superior aesthetic results. This review highlights the application of anterolateral thigh, superficial circumflex iliac artery, deep inferior epigastric perforator, superficial inferior epigastric artery, and flow-through flaps for reconstruction of upper extremity defects. These flaps share several qualities in common: well-concealed donor sites, preservation of major arteries responsible of providing inflow to distal extremity, and potential for a two-team approach (donor and recipient sites). While the choice of flaps should be decided based on individual patient and defect characteristics, FCF should be considered as excellent options to achieve the goals of upper extremity reconstruction.
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Affiliation(s)
- Howard D Wang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Jose C Alonso-Escalante
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Brian H Cho
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ramon A DeJesus
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States.,Division of Plastic, Maxillofacial, and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, United States.,Department of Plastic and Reconstructive Surgery, National Military Center, San Diego, California, United States
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Microsurgical Reconstruction of Traumatic Lower Extremity Defects in the Pediatric Population. Plast Reconstr Surg 2017; 139:998-1004. [PMID: 28002282 DOI: 10.1097/prs.0000000000003156] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few reports focus exclusively on microsurgical reconstruction of traumatic lower extremity defects in children. Hence, the authors felt it prudent to contribute to this area of clinical research. The authors hypothesized that reconstructive success would be comparable to success rates reported in adults, and that young age or concerns regarding vessel size or behavior do not negatively impact surgical outcome. METHODS A retrospective review of microsurgical lower extremity reconstruction cases at two academic medical centers was performed. All pediatric patients who underwent microsurgical reconstruction of traumatic lower extremity defects between 1997 and 2012 were included for analysis. RESULTS Forty flaps transferred in 40 patients with a mean age of 11.4 years (range, 1 to 17 years) were included for analysis. Muscle flaps were predominantly used [n = 23 (57.5 percent)]; however, there was a recent increase in use of fasciocutaneous flaps [n = 16 (40 percent)]. Postoperative complications were seen in 25 percent of patients, with a total flap loss rate of 5 percent. No donor-site complications were observed. The mean postoperative length of hospital stay was 12.9 days (range, 4 to 41 days), with patients returning to full weight-bearing after a mean of 2.6 months (range, 1 to 8 months). CONCLUSIONS Microsurgical reconstruction of traumatic lower extremity defects in the pediatric population is safe. Concerns related to patient age, vessel size, or vessel behavior (i.e., vasospasm) should not detract from offering free flap reconstruction, as they do not negatively impact outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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30
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31
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Kerfant N, Lentini A, Le Nen D, Henry AS, Ta P, Trimaille A, Hu W. [Pediatric lower extremity reconstruction]. ANN CHIR PLAST ESTH 2016; 61:536-542. [PMID: 27427445 DOI: 10.1016/j.anplas.2016.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 11/25/2022]
Abstract
Lower limb multi-tissular injuries are rare in children but require elaborate surgical care considering the child's growth potential, donor-site morbidity and the psychological consequences for the child and his family. This review outlines the various coverage options, from simple to more complex, developing their principles and their results. Technical features of wound repair of the lower limb in children will be detailed. An efficient and ambitious care can give excellent functional outcomes in children, even when extended, multi-tissue lesions members are involved.
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Affiliation(s)
- N Kerfant
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - A Lentini
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - D Le Nen
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - A-S Henry
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - P Ta
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - A Trimaille
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - W Hu
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
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33
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Qassemyar Q, Kolb F. [Complex carcinological head and neck reconstruction in pediatric surgery]. ANN CHIR PLAST ESTH 2016; 61:779-790. [PMID: 27545654 DOI: 10.1016/j.anplas.2016.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/18/2022]
Abstract
Head and neck reconstruction in pediatric oncology, even if it is based on adult experience, presents important characteristics including age-related growth, the type of tumor and donor sites features. Indications of free flaps are rare but required care that should be codified, taking into account the details specific to context, and not giving place for improvisation as it is important that surgical outcomes must be as simple as possible. The objective of this article is not to present the technical details of free flaps harvesting in children because it is what is certainly the least different with adults. The aim is to share our experience of the specificities and singularities of pediatric head and neck reconstruction in order to focus attention to everything that makes this surgery demanding. We present the most common indications, the types of free flaps used for reconstruction, facial location modalities of reconstruction and the perioperative management.
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Affiliation(s)
- Q Qassemyar
- Département de chirurgie plastique et reconstructrice, institut Gustave-Roussy, Cancer campus, Grand Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
| | - F Kolb
- Département de chirurgie plastique et reconstructrice, institut Gustave-Roussy, Cancer campus, Grand Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
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Use of Innovative Technologies in Pediatric Lower Extremity Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e825. [PMID: 27622093 PMCID: PMC5010316 DOI: 10.1097/gox.0000000000000820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Abstract
The anterolateral thigh (ALT) free flap has proven to be a reliable option for the coverage of soft tissue defects in adults and more recently in the pediatric population. When considering the use of the ALT flap in the pediatric patient, there are few studies that detail techniques specific to pediatric free flap management. We present a unique case of a 14- × 8-cm ALT flap used for traumatic wound coverage in a distal tibial injury in a 6-year-old girl. This case highlights innovative techniques in pediatric perioperative free flap monitoring and the use of continuous external tissue expansion to achieve delayed primary closure of the donor site.
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Ramirez AE, Soto CA, Nuñez FJ, Briones CA, Ferj DA, Morovic CG. Free anterolateral thigh perforator flap for sacroiliac defect: First case report in pediatric population. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Emergency Transplantation of Free Flap between Separated Thoraco-Omphalopagus Conjoined Twins. Arch Plast Surg 2016; 43:97-9. [PMID: 26848455 PMCID: PMC4738138 DOI: 10.5999/aps.2016.43.1.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 11/23/2022] Open
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Deneuve S, Qassemyar Q, Blancal JP, Couloignier V, Sainte-Rose C, Janot F, Kolb F. Thoraco dorsal artery perforator flap for trismus release in a young girl. Int J Pediatr Otorhinolaryngol 2015; 79:1949-51. [PMID: 26363893 DOI: 10.1016/j.ijporl.2015.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
Trismus is a frequent complication occurring after treatment of tumors of the pterygomaxillary fossa. Local flaps and full-thickness skin grafts fail to release it because they usually lead to scar contracture in previously irradiated tissues. We propose to release it with a thoracodorsal artery perforator flap, which is feasible in children like other perforator flaps. It is interesting because it is thinner than the anterolateral thigh flap and its scar may be less disgraceful and easier to hide.
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38
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Iida T, Yamamoto T, Yoshimatsu H, Abe N, Tsuchiya M, Nemoto N, Watanabe S. Supermicrosurgical free sensate superficial circumflex iliac artery perforator flap for reconstruction of a soft tissue defect of the ankle in a 1-year-old child. Microsurgery 2015; 36:254-8. [DOI: 10.1002/micr.22525] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/23/2015] [Accepted: 10/13/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Takuya Iida
- Department of Plastic and Reconstructive Surgery; University of Tokyo; 7-3-1 Hongo Tokyo 1138655 Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery; University of Tokyo; 7-3-1 Hongo Tokyo 1138655 Japan
| | - Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery; University of Tokyo; 7-3-1 Hongo Tokyo 1138655 Japan
| | - Naho Abe
- Division of Plastic Surgery; Department of Surgery; Saitama Children's Medical Center; 200 Magome, Iwatsuki-Ku Saitama 3398551 Japan
| | - Masato Tsuchiya
- Division of Plastic Surgery; Department of Surgery; Saitama Children's Medical Center; 200 Magome, Iwatsuki-Ku Saitama 3398551 Japan
| | - Naho Nemoto
- Division of Orthopedic Surgery; Department of Surgery; Saitama Children's Medical Center; 200 Magome, Iwatsuki-Ku Saitama 3398551 Japan
| | - Shoji Watanabe
- Division of Plastic Surgery; Department of Surgery; Saitama Children's Medical Center; 200 Magome, Iwatsuki-Ku Saitama 3398551 Japan
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39
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Hu R, Ren YJ, Yan L, Xiao ZH, Ding F, Li F, Han Q, Cheng WJ, Kan WS. A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children's feet and ankles. Injury 2015. [PMID: 26206164 DOI: 10.1016/j.injury.2015.06.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE High-energy injury to children caused by a traffic accident is usually characterised by extensive soft tissue defects with exposure or loss of tendons and bone at the foot. Segmental loss of the Achilles tendon along with soft tissue defects is a great challenge for microsurgical reconstruction. Free anterolateral thigh (ALT) flap is indicated for reconstruction of such defects because limited local tissues are available. Additionally, iliotibial band in the donor area can be used to reconstruct the damaged tendon. MATERIALS AND METHODS Here we described our successful management of 25 paediatric patients with such high-energy injury at feet and ankles in one-stage transplantation of a free ALT flap and an iliotibial band from January 2008 to January 2013. The tendon defect, ranging from 3 to 16cm in length, was reconstructed with an iliotibial band. The flaps ranged from 5 to 12cm in width and 8 to 18cm in length. RESULTS All the flaps survived completely and no donor site complications were observed. In two flaps there was a small area of distal necrosis which was healed by dressing changes. The mean follow-up time was 14.2 months (from 6 to 24 months). Limb function was assessed using the Maryland Foot Score. The excellent and good rate was 92%. CONCLUSIONS We believe a free ALT flap is ideal for reconstruction of massive soft tissue defects at the foot and ankle in children and an iliotibial band from the same donor site can be used for reconstruction of a damaged tendon.
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Affiliation(s)
- Rui Hu
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Yi-Jun Ren
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China.
| | - Li Yan
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Zhi-Hong Xiao
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Fan Ding
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Fan Li
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Qiong Han
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Wen-Jun Cheng
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Wu-Sheng Kan
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
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40
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Jabir S, Sheikh F, Fitzgerald O’Connor E, Griffiths M, Niranjan N. A systematic review of the applications of free tissue transfer for paediatric lower limb salvage following trauma. J Plast Surg Hand Surg 2015; 49:251-259. [DOI: 10.3109/2000656x.2015.1047781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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41
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Kucuker I, Sezgin B, Tuncer S, Ayhan S. Superior gluteal artery perforator flap for meningomyelocele defect: A saviour when other options vanish. Indian J Plast Surg 2014; 47:149-50. [PMID: 24987225 PMCID: PMC4075208 DOI: 10.4103/0970-0358.129660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ismail Kucuker
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ondokuz Mayis University Hospital, Samsun, Turkey
| | - Billur Sezgin
- Department of Plastic, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Serhan Tuncer
- Department of Plastic, Gazi University Hospital, Ankara, Turkey
| | - Suhan Ayhan
- Department of Plastic, Gazi University Hospital, Ankara, Turkey
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42
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Aboelatta YA, Aly HM. Free tissue transfer and replantation in pediatric patients: technical feasibility and outcome in a series of 28 patients. J Hand Microsurg 2013; 5:74-80. [PMID: 24426679 DOI: 10.1007/s12593-013-0101-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 08/05/2013] [Indexed: 11/26/2022] Open
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.
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Affiliation(s)
- Yasser Abdallah Aboelatta
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Abassia, Cairo, Egypt
| | - Hazem Maher Aly
- Department of Plastic and Reconstructive Surgery, Saint John Hospital, Saint John, NB Canada
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43
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Tang J, Fang T, Song D, Liang J, Yu F, Wang C. Free deep inferior epigastric artery perforator flap for reconstruction of soft-tissue defects in extremities of children. Microsurgery 2013; 33:612-9. [PMID: 23843221 DOI: 10.1002/micr.22127] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 03/25/2013] [Accepted: 03/29/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Juyu Tang
- Department of Hand and Microsurgery; Xiangya Hospital of Central South University; Changsha China
| | - Taolin Fang
- Department of Orthopaedic Surgery; Zhongshan Hospital, Fudan University; Shanghai China
- Department of Plastic Surgery; University of Mississippi Medical Center; Jackson, MS
| | - Dajiang Song
- Department of Hand and Microsurgery; Xiangya Hospital of Central South University; Changsha China
| | - Jieyu Liang
- Department of Hand and Microsurgery; Xiangya Hospital of Central South University; Changsha China
| | - Fang Yu
- Department of Hand and Microsurgery; Xiangya Hospital of Central South University; Changsha China
| | - Congyang Wang
- Department of Hand and Microsurgery; Xiangya Hospital of Central South University; Changsha China
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44
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Yano T, Okazaki M, Kawaguchi R, Suesada N, Tanaka K, Kishimoto S. Tongue reconstruction with minimal donor site morbidity using a deep inferior epigastric perforator (DIEP) free flap in a 6-year-old girl. Microsurgery 2013; 33:487-90. [DOI: 10.1002/micr.22120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/11/2013] [Accepted: 03/15/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Tomoyuki Yano
- Department of Plastic and Reconstructive Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Runa Kawaguchi
- Department of Plastic and Reconstructive Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Nobuko Suesada
- Department of Plastic and Reconstructive Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Kentaro Tanaka
- Department of Plastic and Reconstructive Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Seiji Kishimoto
- Department of Head and Neck Surgery; Tokyo Medical and Dental University; Tokyo Japan
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45
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Preexpanded Perforator Flaps of the Dorsolateral Trunk in Pediatric Patients. Plast Reconstr Surg 2013; 131:1077-1086. [DOI: 10.1097/prs.0b013e3182865dd7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Lawson RD, Tonkin MA. Technical considerations in microsurgical treatment of paediatric hand injuries. Injury 2013; 44:327-30. [PMID: 23352150 DOI: 10.1016/j.injury.2013.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Microsurgical techniques are vital for the treatment of many aspects of trauma in the child, both in initial management and later reconstructive surgery. The basic principles of microsurgery pertain to all patients, but there are nuances of technique and of the psycho-social and peri-operative aspects of treatment which are particularly important in the child. It is these distinctions that are examined in this paper.
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Affiliation(s)
- Richard D Lawson
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, St Leonards NSW 2065, Australia.
| | - Michael A Tonkin
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, St Leonards NSW 2065, Australia
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47
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Radial artery perforator flap and external fixation after gunshot injuries in a 10-year-old boy. J Pediatr Surg 2013; 48:e13-5. [PMID: 23331832 DOI: 10.1016/j.jpedsurg.2012.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/20/2012] [Indexed: 11/23/2022]
Abstract
Air-powered guns can cause serious trauma to body structures. We describe a 10-year-old boy who suffered injuries to his gluteal and thenar regions as a result of a single gunshot. Surgical management included cleansing of the gluteal region, as well as an external fixation device and a fasciosubcutaneous flap based on a perforator branch of the distal radial artery. To the best of our knowledge, this case illustrates the youngest patient to benefit from this kind of perforator flap. We also underline the long-term risk of lead toxicity for this kind of injury.
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48
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Arslan H, Çinar C, Bingöl UA, Yücel OA. Subacute and delayed period microsurgical management of traumatic extremity injuries in pediatric population. Microsurgery 2012; 32:527-32. [DOI: 10.1002/micr.22021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 06/08/2012] [Indexed: 11/08/2022]
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49
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The use of the anterolateral thigh flap to reconstruct extremity defects in a paediatric population. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-010-0499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Wechselberger G, Radauer W, Schimpl G, Kholosy H, Ensat F, Edelbauer M, Hladik M. Lower limb salvage in a 7-month-old infant using free tissue transfer. J Pediatr Surg 2011; 46:1852-4. [PMID: 21930003 DOI: 10.1016/j.jpedsurg.2011.06.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/11/2011] [Accepted: 06/22/2011] [Indexed: 11/30/2022]
Abstract
Free flap reconstruction in infants is extremely rare. A seven-and-a-half-month-old male infant sustained an extensive soft tissue defect on his left knee caused by extravasation of an intraosseous arterenol infusion. A free latissimus dorsi flap was successfully performed for soft tissue reconstruction. Indications, advantages, and outcome of the procedure are discussed.
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Affiliation(s)
- Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzigen Brüder, Teaching Hospital of the Medical University Salzburg, Kajetanerplatz 1, 5020 Salzburg, Austria
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