Pediatric free tissue transfer: A 29-year experience with 433 transfers

Background: Free tissue transfer in pediatric patients represents the ultimate challenge in microsurgery. There have been few large series presented in the literature. The authors report one surgeon's experience over a three-decade period with 433 consecutive cases of free tissue transfer in pediatric patients. These cases consist of a wide range of causes, patient ages (4 months to 16 years), recipient sites, and donor flaps. Methods: The authors reviewed records of 433 consecutive patients that included free tissue transfers to the upper extremity (n = 141), head and neck (n = 165), lower extremity (n = 108), chest and abdomen (n = 16), and other regions (n = 3). The authors analyzed the type of transfer that was performed in each region and their associated complications. The authors outlined their protocols in presurgical design, intraoperative strategy, and postoperative management. Results: Of the 433 cases, there were two failures (success rate, 99.8 percent), seven other major complications that were eventually salvaged, and an additional 33 patients who had minor complications, for an overall complication rate of 9 percent. Conclusions: Microsurgical free tissue transfer procedures in pediatric patients are different from and safer than those in adult patients because pediatric patients present with minimal comorbidities. Meanwhile, the technical considerations are far more complex than those in adult free tissue transfer. However, when the procedures are executed well, these younger patients can achieve superior results within otherwise difficult clinical situations.