Microvascular reconstruction in children-a report of 46 cases.

BACKGROUND : We report microvascular free tissue transfers in pediatric patients in a retrospective series. METHODS : Forty-six children were treated in collaboration between the departments of Pediatric Surgery and Plastic Surgery, Helsinki University Hospital between 1986 and 2004 for microvascular free flap surgery. Trauma, tumor resection, congenital malformation, meningococcal septicaemia, and scars caused the tissue defects. The mean follow-up was 50 months. RESULTS : The overall success rate was 96%. Twenty-five free flaps were transferred to the lower extremity. The most used flap was vascularized fibula. Preoperative angiography or intraoperative anticoagulants were not routinely used. Early reoperations were needed in four cases due to hematoma and in four cases due to thrombosis or impaired blood flow. All attempts of reanastomosis lead to salvage of the flap. CONCLUSION : In cases of severe tissue defects in pediatric patients, microvascular free flap reconstruction is a treatment of choice. A multicenter study for guidelines on preoperative assessment and antitrombotic therapy in pediatric microsurgery is warranted.

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