FREE TISSUE TRANSFER FOR LEG RECONSTRUCTION IN CHILDREN

Twenty-five free tissue transfers for reconstruction after lower limb trauma or release of scar contractures were performed in 23 children o ver an 8-year period. The ages ranged from 2 to 14 years (mean 7.1 yea rs). Fourteen (61%) patients had major associated injuries. The recons truction sites were all in the distal leg. The overall vascular succes s rate was 96%. Three patients underwent re-explorations because of va scular insufficiency. One flap failed and two were salvaged. The cause s of vascular complications were considered to be inadequate debrideme nt of an avulsed vessel, venous kinking and inadequate protection of t he vascular pedicle. The three cases with vascular insufficiency were children with associated injuries on the ipsilateral leg proximally. P ostoperative complications were not uncommon (28%). Six of the seven c omplications occurred in patients with major associated injuries. The mean follow-up was 57 months. Long-term problems such as a limping gai t, frequent flap ulcers, toe contracture or a bulky flap were common. Our results suggest that free tissue transfer is reliable and safe for the reconstruction of major leg injuries in children. Associated inju ries proximal to the reconstructed defects on the ipsilateral leg pred ispose to more vascular complications. Since postoperative complicatio ns and long-term morbidity are common in children, special precautions should be taken with the preoperative assessment, planning, execution of surgery and postoperative care to achieve better results.