Free tissue transfer in pediatric patients.

The majority of reports on free tissue transfer involve adults; few have specifically addressed children. During the past 5 years, 20 free tissue transfers were performed in 19 pediatric patients. Patients ranged in age from 3 to 17 years, with a mean age of 10 years. Eight patients were 6 years and younger; 11 patients were 13 to 17 years old. Soft-tissue defects requiring reconstruction resulted from acute trauma in 12 patients, tumor ablation in 5 patients, infection in 1 patient, and hemifacial atrophy in 1 patient. Soft-tissue defects occurred in the lower extremity in 16 patients, the head and neck in 2 patients, and the upper extremity in 1 patient. The donor tissues included the latissimus dorsi muscle in 7 patients, the radial forearm flap in 7 patients, the rectus abdominis muscle in 4 patients, and the scapular fasciocutaneous flap in 2 patients. All patients received aspirin preoperatively. Mean operative time was 6.5 hours, with a range of 4 to 8 hours. Postoperative heparin infusion was used for 5 days in 7 of the 8 patients age 6 years and younger. All free tissue transfers were successful. One flap to a traumatic foot wound (patient age, 4 years) had a venous thrombosis on the second postoperative day, and was successfully treated with urokinase and heparin infusions and repeat venous anastomosis. There were no other significant morbidities and no mortalities. Hospitalization following free tissue transfer averaged 13 days, with a range of 6 to 37 days. Follow-up has averaged 31 months, with a range of 8 to 59 months. Late complications included a progressive equinus deformity 3 years after a heel reconstruction following a lawn mower injury and a contour deformity following a scapula flap to a gunshot wound of the foot. Sixteen of the 17 lower extremity reconstructions have shown normal growth. No growth disturbances or significant functional losses have occurred at the donor sites. Most patients have maintained normal extremity function including participation in athletics. Special considerations in this group of patients have included subtherapeutic heparin infusion during the postoperative period in young children, minimizing the aesthetic defect at the donor site and providing composite reconstructions whenever possible.