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Microsurgical Reconstruction of Traumatic Lower Extremity Defects in the Pediatric Population

Momeni, Arash M.D.; Lanni, Michael B.S.; Levin, L. Scott M.D.; Kovach, Stephen J. M.D.

Plastic & Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 998–1004
doi: 10.1097/PRS.0000000000003156
Reconstructive: Lower Extremity: Original Articles
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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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Palo Alto, Calif.; and Philadelphia, Pa.

From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center; and the Division of Plastic Surgery and the Department of Orthopedic Surgery, University of Pennsylvania Health Systems.

Received for publication April 10, 2016; accepted August 24, 2016.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch. On the iPad, tap on the Hot Topics icon.

Arash Momeni, M.D., Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, Calif. 94304, amomeni@stanford.edu

©2017American Society of Plastic Surgeons