Jabir Shehab, Sheikh Fayad, Fitzgerald O'Connor Edmund, Griffiths Matthew, Niranjan Niri
a 1 St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital , Court Road, Chelmsford CM1 7ET, UK.
b 2 Basildon and Thurrock University Hospitals NHS Foundation Trust , Nethermayne, Basildon SS16 5NL, UK.
J Plast Surg Hand Surg. 2015 Oct;49(5):251-259. doi: 10.3109/2000656X.2015.1047781. Epub 2015 May 22.
Since the advent of microsurgical free tissue transfer in the 1960s, it has now become an indispensable part of limb salvage surgery. However, its application in children was initially met with concerns regarding vessel diameter, increased potential for vasospasm and its potential impact on normal growth and development. This resulted in its restriction to specialist paediatric facilities. With improvements and greater confidence in microsurgical techniques, more units are starting to rewrite the initially popularised narrative regarding free tissue transfer in paediatric limb salvage following trauma. A systematic review was undertaken, using the PRISMA criteria for systematic reviews, of all published literature relating to the use of free flaps in paediatric lower limb salvage following trauma.
Inclusion and exclusion criteria were defined and Medline, Embase, PubMed and Google Scholar databases were searched from inception to September 2014 with the following search terms: "free tissue transfer", "free flaps", "microvascular free tissue transfer", "paediatric/pediatric", "children", "lower limb", "trauma" and "reconstruction".
A total of 375 studies were retrieved following the electronic database search, of which 23 studies met the inclusion criteria. Two further studies were found via a hand-search of the reference lists of the retrieved studies. A total of 25 studies were, thus, included in the review.
This study presents a synthesis of the literature available on the indications, timing, selection, viability, complications and functional outcome of free tissue transfer following lower limb trauma in paediatric patients. Limitations of current studies with potential areas for further research are also discussed.
自20世纪60年代显微外科游离组织移植问世以来，它现已成为肢体挽救手术不可或缺的一部分。然而，其在儿童中的应用最初引发了人们对血管直径、血管痉挛可能性增加及其对正常生长发育潜在影响的担忧。这导致其应用局限于专业儿科机构。随着显微外科技术的改进以及信心的增强，更多单位开始改写最初关于创伤后小儿肢体挽救中游离组织移植的普遍说法。本研究采用系统评价的PRISMA标准，对所有已发表的有关创伤后小儿下肢挽救中使用游离皮瓣的文献进行了系统评价。
明确纳入和排除标准，并检索Medline、Embase、PubMed和谷歌学术数据库，检索时间从建库至2014年9月，检索词如下：“游离组织移植”、“游离皮瓣”、“微血管游离组织移植”、“儿科/小儿”、“儿童”、“下肢”、“创伤”和“重建”。
电子数据库检索共检索到375项研究，其中23项研究符合纳入标准。通过手工检索所检索研究的参考文献列表又发现了另外两项研究。因此，本综述共纳入25项研究。
本研究综合了有关小儿患者下肢创伤后游离组织移植的适应证、时机、选择、存活情况、并发症及功能结果的现有文献。还讨论了当前研究的局限性及潜在的进一步研究领域。
