Reconstruction of Lower Extremity with Perforator Free Flaps by Free Style Approach in Pediatric Patients

Abstract

Pediatric reconstruction using microsurgery is accepted normal practice, and the use of perforator flaps is slowly increasing. This study presents clinical work using various perforator free flaps by free style approach to reconstruct lower extremity soft tissue defects in pediatric patients and evaluates its efficacy. Between June 2002 and February 2011, 32 cases (mean age: 10.1 years) were reconstructed with free style perforator free flaps. Retrospective evaluations for flap survival, growth character, and other associated morbidities were performed. Flaps used in this series are anterolateral thigh (ALT) perforator, superficial circumflex iliac artery perforator (SCIP), upper medial thigh perforator, and posterior interosseous perforator free flaps. The free style approach for pedicle dissection was successful in all cases. Early postoperative complications were 15.6% from hematoma collection to partial loss of flap. Although there was no total loss in this series, one case needed additional flap coverage to cover the partial loss of the flap. The long-term follow-up showed contracture along the margin, with 16% needing a releasing procedure. Bone growth was not affected by flap contracture. The overall results show perforator flaps using the free style approach to be a reliable and feasible approach for lower extremity reconstruction in the pediatric population.

Keywords

pediatric reconstruction - free style reconstruction - perforator flaps

• References

• 1 Harii K, Ohmori K. Free groin flaps in children. Plast Reconstr Surg 1975; 55: 588-592
• 2 Van Beek AL, Wavak PW, Zook EG. Microvascular surgery in young children. Plast Reconstr Surg 1979; 63: 457-462
• 3 Banic A, Wulff K. Latissimus dorsi free flaps for total repair of extensive lower leg injuries in children. Plast Reconstr Surg 1987; 79: 769-775
• 4 Parry SW, Toth BA, Elliott LF. Microvascular free-tissue transfer in children. Plast Reconstr Surg 1988; 81: 838-840
• 5 Yildirim S, Calikapan GT, Akoz T. Reconstructive microsurgery in pediatric population-a series of 25 patients. Microsurgery 2008; 28: 99-107
• 6 Duteille F, Lim A, Dautel G. Free flap coverage of upper and lower limb tissue defects in children: a series of 22 patients. Ann Plast Surg 2003; 50: 344-349
• 7 Yücel A, Aydin Y, Yazar S, Altintaş F, Senyuva C. Elective free-tissue transfer in pediatric patients. J Reconstr Microsurg 2001; 17: 27-36
• 8 Hong JP, Kim EK. Sole reconstruction using anterolateral thigh perforator free flaps. Plast Reconstr Surg 2007; 119: 186-193
• 9 Hong JP, Shin HW, Kim JJ, Wei FC, Chung YK. The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity. Plast Reconstr Surg 2005; 115: 142-147
• 10 Dayan JH, Lin CH, Wei FC. The versatility of the anterolateral thigh flap in lower extremity reconstruction. Handchir Mikrochir Plast Chir 2009; 41: 193-202
• 11 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109: 2219-2226 , discussion 2227–2230
• 12 Van Landuyt K, Hamdi M, Blondeel P, Tonnard P, Verpaele A, Monstrey S. Free perforator flaps in children. Plast Reconstr Surg 2005; 116: 159-169
• 13 Gharb BB, Salgado CJ, Moran SL , et al. Free anterolateral thigh flap in pediatric patients. Ann Plast Surg 2011; 66: 143-147
• 14 Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg 2004; 114: 910-916
• 15 Shenaq SM, Dinh TA. Pediatric microsurgery. Reconstruction by free tissue transfer. Clin Plast Surg 1990; 17: 85-94
• 16 Lickstein LH, Bentz ML. Reconstruction of pediatric foot and ankle trauma. J Craniofac Surg 2003; 14: 559-565
• 17 Rinker B, Valerio IL, Stewart DH, Pu LL, Vasconez HC. Microvascular free flap reconstruction in pediatric lower extremity trauma: a 10-year review. Plast Reconstr Surg 2005; 115: 1618-1624
• 18 Lin CH, Mardini S, Wei FC, Lin YT, Chen CT ; CH L. Free flap reconstruction of foot and ankle defects in pediatric patients: long-term outcome in 91 cases. Plast Reconstr Surg 2006; 117: 2478-2487
• 19 Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg 2009; 123: 230-235
• 20 Khouri RK, Shaw WW. Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases. J Trauma 1989; 29: 1086-1094
• 21 Kim EK, Kang BS, Hong JP. The distribution of the perforators in the anterolateral thigh and the utility of multidetector row computed tomography angiography in preoperative planning. Ann Plast Surg 2010; 65: 155-160
• 22 Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S, Fujitsu M. Minimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema: is it effective for stage III and IV?. Ann Plast Surg 2004; 53: 261-266
• 23 Chiang YC, Jeng SF, Yeh MC, Liu YT, Chen HT, Wei FC. Free tissue transfer for leg reconstruction in children. Br J Plast Surg 1997; 50: 335-342