Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival?

Liu, Shuo; Zhang, Wenbo; Yu, Yanxin; Wang, Yang; Mao, Chi; Guo, Chuanbin; Yu, Guang‐Yan; Peng, Xin

doi:10.1002/lary.27442

Cited by 19 publications

(34 citation statements)

References 47 publications

(158 reference statements)

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“…The facial artery and vein were most frequently used for free flap anastomosis in pediatric patients, which reflects previously reported common practices, most likely due to ease of dissection and consistent availability of vessels. 3,6,8,9 Closing osteotomies were required in most patients in our study for optimal reconstruction. No complications from closing osteotomies were reported, which is consistent with the adult literature showing osteotomies do not contribute to complications in fibula flaps.…”

Section: Discussionmentioning

confidence: 88%

“…Fibula flap reconstruction of pediatric maxillary and mandibular defects provides restoration of large structural defects, with minimal post-operative morbidity in the short and long-term perioperative periods. 8 Most facial defects were acquired from oncologic resection of benign and malignant tumors. Although pre and post-operative chemotherapies were uncommon in our patient population, preoperative chemotherapy and radiation did not appear to affect long-term wound healing.…”

Section: Discussionmentioning

confidence: 99%

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Post‐operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps

et al. 2022

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Educational Objective Assess outcomes of pediatric facial reconstruction with fibula free flaps. Objectives Free flap reconstruction of complex maxillofacial defects in pediatric patients is rare. Post‐operative complications, donor site morbidity, impact on craniofacial growth, and oro‐dental rehabilitation are unknown. Our study assesses the outcomes of pediatric maxillofacial reconstruction with composite fibula free flaps. Study Design Retrospective chart review. Methods Multi‐institutional retrospective chart review from 2000 to 2020 on pediatric patients undergoing maxillomandibular reconstruction with fibula free flaps. Results Eighty‐seven patients underwent 89 surgeries; 5 maxillary and 84 mandibular defects. Median age: 12 years. Defects were acquired following resection of sarcoma/carcinoma 44% or benign tumors 50%. 73% of cases had immediate free flap reconstruction. Closing osteotomies were reported in 74%; 1 in 40%, 2 in 27%, and more than 2 in 6.7%. Hardware was used in 98% and removed in 25%. 9.2% demonstrated long‐term hardware exposure, greater than 3 months following reconstruction. Short‐term complications: wound infection 6.7%, flap salvage/failure 2.2%, fistula 1.1%, and compromised craniofacial growth: 23%. Two patients developed trismus. Long‐term fibula donor site complications: hypertrophic scarring: 3.4%, dysesthesia: 1.1%, and long‐term gait abnormality: 1.1%. Dental rehabilitation was performed in 33%. Post‐operative speech outcomes showed 94% with fully intelligible speech. Conclusion Pediatric maxillary and mandible defects repaired with fibula free flaps demonstrated complication rates comparable to the adult free flap population. Long‐term follow‐up did not demonstrate adverse outcomes for craniofacial growth. Hardware for flap retention was utilized and remained in place with minimal exposure. Post‐operative gait abnormality is rare. Level of Evidence 3 Laryngoscope, 133:302–306, 2023

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Post‐operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps

et al. 2022

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“…This can be easily explained as follows. The blood supply to the flap is affected by the second surgery due to the destruction of local blood vessels during the initial surgery, the probability of complications, such as infection and delayed healing are increased, and the tension of the surrounding tissues is increased by performing multiple local flap translocations, which is also a risk factor [ 27 ]. Although the variable of secondary surgery was excluded during multifactorial logistic regression, we reintroduced it into the model, considering the prevalence of secondary surgery in the removal of body surface tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Smoking and lower protein levels were more consistently identified as risk factors for flap healing [ 8 – 13 ]. Other factors considered to be associated with flap prognosis include radiation history [ 14 ], diabetes [ 15 ], age [ 16 ], defect site and flap size [ 17 ], and hypertension [ 8 ]. In our clinical work, we cannot reject patients with histories including smoking, advanced age, or poor nutritional status.…”

Section: Introductionmentioning

confidence: 99%

Identification and Validation of a Novel Model: Predicting Short-Term Complications After Local Flap Surgery for Skin Tumor Removal

et al. 2022

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Background The aim was to analyze the risk factors for the occurrence of complications after local flap transfer and to construct a simple prediction model to help surgeons in the perioperative screening of high-risk patients. Material/Methods Short-term complications were defined as any postoperative infection, dehiscence, bleeding, subcutaneous effusion, fat liquefaction, arteriovenous crisis, and tissue necrosis that required medical consultation or intervention. To explore 16 factors influencing short-term complications after local flap transfer, least absolute shrinkage and selection operator (LASSO) logistic regression was used to reduce the dimensionality of the data and to screen for predictors. Independent risk factors affecting the development of complications after local flap transfer were analyzed using logistic multiple regression models. The consistency (C-)index, receiver operating characteristic (ROC) curves, and calibration curves were used to check the model’s discrimination and calibration. Decision curve analysis (DCA) curves were used to evaluate the clinical applicability of this model, and internal validation was assessed using bootstrap validation. Results The C-index of the nomogram model to predict short-term complications after local flap transfer was 0.763 (95% CI: 0.702–0.824), the area under the ROC curve was 0.763, and the internal validation C-index was 0.747. The calibration curve showed good agreement between observed and predicted values, and the DCA showed the model can benefit patients. Conclusions The model identified the relevant factors influencing short-term complications after local flap transfer, facilitating the identification and targeted intervention of patients at high risk of flap complications after surgery.

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“…Flap failure following pediatric microvascular reconstruction has ranged from 0% to 12%, and rates of minor complications have been reported to be as low as 9% and as high as 67%. [ 10 12 13 14 15 ] The majority of these studies have been single-surgeon case reports or single-institution cohort studies.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Complication Rates of Free Flap Reconstruction in Pediatric Patients

Allam

Shah

Cadwell

et al. 2022

Journal of Indian Association of Pediatric Surgeons

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Introduction: While there is extensive literature investigating surgical outcomes in free flaps for adults, there is a dearth of information on the efficacy of flap use in the pediatric population. This study is the first to measure complication rates following pediatric free flap reconstruction on a national level. Methods: All pediatric free flap cases between 2012 and 2018 were identified and stratified by type of flap using current procedural terminology codes assigned to the primary procedure in the National Surgical Quality Improvement Program database. Each entry included the recipient location of the flap, postoperative complications, and demographics. Chi-square analysis was used to compare complication rates across various flap groupings. In addition, univariate and multivariate analyses were used to identify independent predictors of flap complications or failure. Results: Multivariate regression analysis demonstrated that compared to bone flaps, there is increased risk of nonbleeding complications in skin (Odds Ratio (OR) =7.7, P = 0.029), muscle (OR = 10.6, P = 0.012), and osteocutaneous flaps (OR = 10.8, P = 0.018). Flap of the trunk (OR = 40.9, P = 0.003) and upper extremities (OR = 32.9, P = 0.041) had a higher odds of bleeding complications compared to head-and-neck flaps. Regression analysis also showed that older age is associated with bleeding complications, with patients aged 5–11 years (OR = 38.5, P = 0.027) and 12–17 years (OR = 30.6, P = 0.038) having greater rates compared to patients under the age of 2. The pediatric flap reoperation rate was found to be 3.6%–4.7%, with the highest flap anastomotic complication rate in the head-and-neck region (6.9%–8.0%). Conclusion: Free flap reconstruction across flap type, anatomic location, and age ranges are safe and efficacious in the pediatric population.

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Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival?

Abstract: 4. Laryngoscope, 2018.

Cited by 19 publications

References 47 publications

Post‐operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps

Post‐operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps

Identification and Validation of a Novel Model: Predicting Short-Term Complications After Local Flap Surgery for Skin Tumor Removal

Evaluation of Complication Rates of Free Flap Reconstruction in Pediatric Patients

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