FREE TISSUE TRANSFER IN PEDIATRIC-PATIENTS

The majority of reports on free tissue transfer involve adults; few ha ve specifically addressed children, During the past 5 years, 20 free t issue transfers were performed in 19 pediatric patients. Patients rang ed in age from 3 to 17 years, with a mean age of 10 years, Eight patie nts were 6 years and younger; 11 patients were 13 to 17 years old, Sof t-tissue defects requiring reconstruction resulted from acute trauma i n 12 patients, tumor ablation in 5 patients, infection in 1 patient, a nd hemifacial atrophy in 1 patient. Soft-tissue defects occurred in th e lower extremity in 16 patients, the head and neck in 2 patients, and the upper extremity in 1 patient, The donor tissues included the lati ssimus dorsi muscle in 7 patients, the radial forearm flap in 7 patien ts, the rectus abdominis muscle in 4 patients, and the scapular fascio cutaneous flap in 2 patients. All patients received aspirin preoperati vely. Mean operative time was 6.5 hours, with a range of 4 to 8 hours. Postoperative heparin infusion was used for 5 days in 7 of the 8 pati ents age 6 years and younger. All free tissue transfers were successfu l. One flap to a traumatic foot wound (patient age, 4 years) had a ven ous thrombosis on the second postoperative day, and was successfully t reated with urokinase and heparin infusions and repeat venous anastomo sis. There were no other significant morbidities and no mortalities. H ospitalization following free tissue transfer averaged 13 days, with a range of 6 to 37 days, Follow-up has averaged 31 months, with a range of 8 to 59 months. Late complications included a progressive equinus deformity 3 years after a heel reconstruction following a lawn mower i njury and a contour deformity following a scapula flap to a gunshot wo und of the foot. Sixteen of the 17 lower extremity reconstructions hav e shown normal growth, No growth disturbances or significant functiona l losses have occurred at the donor sites. Most patients have maintain ed normal extremity function including participation in athletics. Spe cial considerations in this group of patients have included subtherape utic heparin infusion during the postoperative period in young childre n, minimizing the aesthetic defect at the donor site and providing com posite reconstructions whenever possible.