Long-term Outcomes after Pediatric Free Flap Reconstruction

Lee W.T. Alkureishi*, Chad A. Purnell, Patricia Park, Bruce S. Bauer, Neil A Fine, Mark Sisco

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction Whereas free tissue transfer has evolved to minimize morbidity in adults, less is known about outcomes after free flaps in children. This study sought to assess short- and long-term outcomes after microvascular reconstruction in the pediatric population. Methods Short- and long-term outcomes of free tissue transfer were assessed using chart-review and quality-of-life surveys. The Pediatric Outcomes Data Collection Instrument was used to evaluate overall health, pain, and ability to participate in normal daily and more vigorous activities. Patient or parent responses were compared against normative data. Results Forty-two patients underwent 48 flap reconstructions at a mean age of 8 years. Median follow-up was 14.9 years. Indications included congenital nevi (n = 19, 42%), lymphatic/vascular malformations (n = 8, 19%), and trauma/burns (n = 6, 14%). There were 21 fasciocutaneous (44%), 19 muscle/myocutaneous (40%), 6 fascial/peritoneal (13%), and 2 osteocutaneous flaps (4%). Major flap complications were observed in 4 patients (9%), whereas major donor-site complications occurred in 2% (1 patient). Valid contact information was available for 25 patients; 16 of these completed surveys (64%). Pediatric Outcomes Data Collection Instrument scores for mobility (median, 52), sports/physical functioning (median, 56), happiness (median, 50), and pain/comfort (median, 56) were not significantly different from normative population score of 50. Similarly, median global functioning score was 99 (maximum, 100) and did not differ between flap types. Discussion Free tissue transfer in the pediatric population is reliable and well-tolerated over time. Surgeons should not hesitate to use free flaps when clinically indicated for pediatric patients.

Original languageEnglish (US)
Pages (from-to)456-461
Number of pages6
JournalAnnals of plastic surgery
Volume81
Issue number4
DOIs
StatePublished - Oct 1 2018

Fingerprint

Free Tissue Flaps
Pediatrics
Population
Pain
Happiness
Vascular Malformations
Aptitude
Nevus
Burns
Sports
Quality of Life
Tissue Donors
Morbidity
Muscles
Health
Wounds and Injuries

Keywords

  • free flaps
  • free tissue transfer
  • giant congenital melanocytic nevus
  • long-term outcomes
  • microvascular surgery
  • pediatric reconstruction

ASJC Scopus subject areas

  • Surgery

Cite this

Alkureishi, L. W. T., Purnell, C. A., Park, P., Bauer, B. S., Fine, N. A., & Sisco, M. (2018). Long-term Outcomes after Pediatric Free Flap Reconstruction. Annals of plastic surgery, 81(4), 456-461. https://doi.org/10.1097/SAP.0000000000001549
Alkureishi, Lee W.T. ; Purnell, Chad A. ; Park, Patricia ; Bauer, Bruce S. ; Fine, Neil A ; Sisco, Mark. / Long-term Outcomes after Pediatric Free Flap Reconstruction. In: Annals of plastic surgery. 2018 ; Vol. 81, No. 4. pp. 456-461.
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Alkureishi, LWT, Purnell, CA, Park, P, Bauer, BS, Fine, NA & Sisco, M 2018, 'Long-term Outcomes after Pediatric Free Flap Reconstruction', Annals of plastic surgery, vol. 81, no. 4, pp. 456-461. https://doi.org/10.1097/SAP.0000000000001549

Long-term Outcomes after Pediatric Free Flap Reconstruction. / Alkureishi, Lee W.T.; Purnell, Chad A.; Park, Patricia; Bauer, Bruce S.; Fine, Neil A; Sisco, Mark.

In: Annals of plastic surgery, Vol. 81, No. 4, 01.10.2018, p. 456-461.

Research output: Contribution to journalArticle

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T1 - Long-term Outcomes after Pediatric Free Flap Reconstruction

AU - Alkureishi, Lee W.T.

AU - Purnell, Chad A.

AU - Park, Patricia

AU - Bauer, Bruce S.

AU - Fine, Neil A

AU - Sisco, Mark

PY - 2018/10/1

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N2 - Introduction Whereas free tissue transfer has evolved to minimize morbidity in adults, less is known about outcomes after free flaps in children. This study sought to assess short- and long-term outcomes after microvascular reconstruction in the pediatric population. Methods Short- and long-term outcomes of free tissue transfer were assessed using chart-review and quality-of-life surveys. The Pediatric Outcomes Data Collection Instrument was used to evaluate overall health, pain, and ability to participate in normal daily and more vigorous activities. Patient or parent responses were compared against normative data. Results Forty-two patients underwent 48 flap reconstructions at a mean age of 8 years. Median follow-up was 14.9 years. Indications included congenital nevi (n = 19, 42%), lymphatic/vascular malformations (n = 8, 19%), and trauma/burns (n = 6, 14%). There were 21 fasciocutaneous (44%), 19 muscle/myocutaneous (40%), 6 fascial/peritoneal (13%), and 2 osteocutaneous flaps (4%). Major flap complications were observed in 4 patients (9%), whereas major donor-site complications occurred in 2% (1 patient). Valid contact information was available for 25 patients; 16 of these completed surveys (64%). Pediatric Outcomes Data Collection Instrument scores for mobility (median, 52), sports/physical functioning (median, 56), happiness (median, 50), and pain/comfort (median, 56) were not significantly different from normative population score of 50. Similarly, median global functioning score was 99 (maximum, 100) and did not differ between flap types. Discussion Free tissue transfer in the pediatric population is reliable and well-tolerated over time. Surgeons should not hesitate to use free flaps when clinically indicated for pediatric patients.

AB - Introduction Whereas free tissue transfer has evolved to minimize morbidity in adults, less is known about outcomes after free flaps in children. This study sought to assess short- and long-term outcomes after microvascular reconstruction in the pediatric population. Methods Short- and long-term outcomes of free tissue transfer were assessed using chart-review and quality-of-life surveys. The Pediatric Outcomes Data Collection Instrument was used to evaluate overall health, pain, and ability to participate in normal daily and more vigorous activities. Patient or parent responses were compared against normative data. Results Forty-two patients underwent 48 flap reconstructions at a mean age of 8 years. Median follow-up was 14.9 years. Indications included congenital nevi (n = 19, 42%), lymphatic/vascular malformations (n = 8, 19%), and trauma/burns (n = 6, 14%). There were 21 fasciocutaneous (44%), 19 muscle/myocutaneous (40%), 6 fascial/peritoneal (13%), and 2 osteocutaneous flaps (4%). Major flap complications were observed in 4 patients (9%), whereas major donor-site complications occurred in 2% (1 patient). Valid contact information was available for 25 patients; 16 of these completed surveys (64%). Pediatric Outcomes Data Collection Instrument scores for mobility (median, 52), sports/physical functioning (median, 56), happiness (median, 50), and pain/comfort (median, 56) were not significantly different from normative population score of 50. Similarly, median global functioning score was 99 (maximum, 100) and did not differ between flap types. Discussion Free tissue transfer in the pediatric population is reliable and well-tolerated over time. Surgeons should not hesitate to use free flaps when clinically indicated for pediatric patients.

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