Microsurgical Reconstruction of Traumatic Lower Extremity Defects in the Pediatric Population.

Background: Very few reports focus exclusively on microsurgical reconstruction of traumatic lower extremity defects in children. As such, we felt it prudent to contribute to this area of clinical research. We 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 (University of Pennsylvania and Duke University) 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 were transferred in 40 patients with a mean age of 11.4 years (range, 1 to 17 years) were included for final analysis. Muscle flaps were predominantly used (N=23; 57.5%); however, with a recent increase in fasciocutaneous flaps (N=16; 40%). Postoperative complications were seen in 25% of patients with total flap loss rate of 5%. 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 as evidenced by a flap survival rate of 95%. 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. (C)2016American Society of Plastic Surgeons

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