Momeni Arash, Lanni Michael, Levin L Scott, Kovach Stephen J
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.
Plast Reconstr Surg. 2017 Apr;139(4):998-1004. doi: 10.1097/PRS.0000000000003156.
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.
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.
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).
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.
很少有报告专门关注儿童创伤性下肢缺损的显微外科重建。因此，作者认为为这一临床研究领域做出贡献是审慎之举。作者假设重建成功率将与成人报告的成功率相当，并且年轻年龄或对血管大小或行为的担忧不会对手术结果产生负面影响。
对两个学术医疗中心的显微外科下肢重建病例进行回顾性研究。纳入1997年至2012年间接受创伤性下肢缺损显微外科重建的所有儿科患者进行分析。
分析纳入了40例患者的40个皮瓣移植，患者平均年龄11.4岁（范围1至17岁）。主要使用肌皮瓣[n = 23（57.5%）]；然而，最近筋膜皮瓣的使用有所增加[n = 16（40%）]。25%的患者出现术后并发症，皮瓣总丢失率为5%。未观察到供区并发症。术后平均住院时间为12.9天（范围4至41天），患者平均2.6个月（范围1至8个月）后恢复完全负重。
儿科人群创伤性下肢缺损的显微外科重建是安全的。与患者年龄、血管大小或血管行为（即血管痉挛）相关的担忧不应妨碍提供游离皮瓣重建，因为它们不会对结果产生负面影响。
临床问题/证据水平：治疗性，IV级。
