Pediatric microvascular reconstruction: a report from the Microvascular Committee.
BACKGROUND
Free tissue transfer is an integral part of modern head and neck surgery in the adult population. Its use in the pediatric population has not been well described. Recently, there has been an increase in the application of these techniques in the pediatric population. The morbidity of free tissue transfer in small pediatric patients and its effect on growth has not been well described.


OBJECTIVE
To evaluate the utility of microvascular reconstruction techniques in the pediatric population.


METHODS
A consensus study was performed by the microvascular committee of the American Academy of Otolaryngology-Head and Neck Surgery. Thirty active microvascular surgeons reviewed their databases to find patients less than 21 years of age who underwent free tissue transfer.


RESULTS
49 free tissue transfers performed between 1999 and 2005. The mean age was 12.1 years (age range, 3-21). The types of flaps transferred were radial forearm (10), fibula (21), rectus abdominus (7), scapula (1), latissimus dorsi (3), groin (1), gracillus (4), and jejunum (2). Morbidity at the donor site was relatively minimal. Five patients developed wound breakdown. One of these required return to the operating room. Morbidity at the reconstructed site was also rare. Patients were followed for an average of 49 months (range, 1-131 months), and no problems were noted with growth at the donor or recipient sites.


CONCLUSIONS
Free flaps in the pediatric population have morbidity and survival similar to those in the adult population.


CONCLUSIONS
While indications differ from those in the adult population, these techniques are viable and valuable and should be considered in the pediatric reconstructive paradigm.
Arnold
David J
DJ
Department of Otolaryngology--Head and Neck Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA. djarnold@miami.edu
Wax
Mark K
MK
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006085:Graft Survival; D006801:Humans; D008866:Microsurgery / Q000379:methods* / Q000592:standards*; D010036:Otolaryngology / Q000379:methods* / Q000592:standards*; D010606:Pharmacy and Therapeutics Committee; D011183:Postoperative Complications / Q000453:epidemiology; D013524:Surgical Flaps; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000592:standards*