Abstract
Introduction
Published standards for the management of open extremity fractures have improved limb
salvage, fracture union, and deep infection rates, but the aesthetic and functional
importance of our flap choices has been overlooked. Thin and superthin free flaps
exhibit advantages over traditional free flaps in some situations but have seldom
been reported in children. The aim of this paper is to present our experience of thin
and superthin free flaps in pediatric extremity reconstruction.
Methods
Children (≤13 years) who underwent soft tissue reconstruction using a thin and superthin
free flap following major extremity trauma are presented.
Results
Five patients (5 flaps) met the inclusion criteria. The median age was 9 (range 6–13).
There were 3 Gustilo IIIB open fractures and 2 multiplanar degloving injuries. The
median mangled extremity severity score (MESS) was 4 (range 2–6). The median time
from injury to definitive soft tissue closure was 72 h (range 28–120 h). Four anterolateral
thigh (ALT) flaps were raised as thin flaps, and 1 superficial circumflex iliac artery
perforator (SCIP) was raised as a superthin flap. There was one re-exploration owing
to venous congestion, and a second venous anastomosis was performed to enhance flap
drainage. The same ALT flap exhibited necrosis at one margin, which was debrided and
grafted before discharge. There were no other flap complications. No flap-related
secondary surgeries were required.
Conclusion
Thin and superthin free flaps are viable options in pediatric extremity reconstruction.
They exhibit excellent aesthetic and functional contouring when a slender fasciocutaneous
flap is needed, especially when body habitus renders traditional options unfavorable.
Keywords
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Article info
Publication history
Published online: June 27, 2022
Accepted:
June 21,
2022
Received:
January 18,
2022
Footnotes
This work has not been presented at any meeting, wholly or in part.
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
