ABSTRACT
Although many trauma centers are primarily “adult-oriented,” the presentation of unusual
life- or limb-threatening wounds in children occasionally have mandated urgent microvascular
tissue transfer for salvage. For these rare instances, should a microsurgical team
accustomed to dealing with adult trauma patients even attempt to meet such a specialized
challenge?
A retrospective analysis of all free flaps performed by the author's team in trauma
patients from 1984 to 1993, revealed only 10 pediatric patients who had had 11 separate
free flaps. Their ultimate success rate was 90.9 percent-statistically the same rate
(87.0 percent) as for 93 adult free flaps. The majority of these pediatric flaps were
for urgent coverage of the lower extremity and they were all successful, eliminating
any need for traditional pedicled flaps during the same time period. Improvement in
technical expertise and judgment seemed to be more important factors than actual chronological
age in determining free-flap success in general, and in children in particular. Therefore,
free flaps in the pediatric population can be appropriately performed in an adult trauma center.
