Use of Innovative Technologies in Pediatric Lower Extremity Reconstruction

Mountziaris, Paschalia M.; Soteropulos, Carol E.; Rezak, Kristen; Patel, Ashit

doi:10.1097/gox.0000000000000820

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…Mountziaris et al achieved delayed primary closure of an ALT donor site on a 6-year-old after a motor vehicle accident that resulted in a distal leg injury and large soft-tissue defect with the application of the DermaClose device for 1 week. 8 Topaz et al achieved a staged excision of a giant forehead congenital nevus in an infant after applying CETE devices for six cycles, from the age of 3 months to 2 years. 9 The device allowed for an early start and conclusion of the reconstructive process.…”

Section: Discussionmentioning

confidence: 99%

Management of Large Pediatric Wound Defects Using a Continuous External Tissue Expander

Choi

Mehta

Luo

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Both internal and external tissue expanders take advantage of the innate adaptive mechanisms the skin exerts in response to mechanical tension, known as the stress-relaxation phenomenon. Internal tissue expander use is time-consuming and can be complicated by infection and extrusion. In this case series, continuous external tissue expanders used to manage large pediatric wounds were assessed. Fourteen patients (ages: 4 days to 17 years) with large wounds underwent continuous external tissue expansion intraoperatively. The success of wound closure was assessed. In addition, the size of the patient’s wounds, duration of device application, and postoperative complications were evaluated. The continuous external tissue expander was applied to wound sizes ranging from 14.7 to 560 cm 2 for 5 to 10 days until the wound was amenable for direct closure. In 11 of the 14 patients, delayed primary closure was achieved. The device significantly reduced the wound sizes of the remaining three cases (average 80% size reduction). There was no incidence of wound dehiscence or infection. This case series demonstrates the benefit of the continuous external tissue expansion in managing pediatric wounds that would not otherwise be amenable to primary closure. The method allows for timely closure with limited risk of infection or extrusion, and should be in the armamentarium of reconstructive plastic surgeons.

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Section: Discussionmentioning

confidence: 99%

Management of Large Pediatric Wound Defects Using a Continuous External Tissue Expander

Choi

Mehta

Luo

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…Tissue expansion before flap harvesting can offer a solution but is not applicable in urgent reconstruction after trauma. Innovative techniques such as DermaClose with continuous external tissue expansion (CETE) offering delayed tension free primary closure should be tested on a wider scale [49,50].…”

Section: Free Alt Flap In Foot Reconstructionmentioning

confidence: 99%

The Free Anterolateral Thigh (ALT) Flap for Microsurgical Reconstruction of Traumatic Defects in Pediatric Foot

Christopoulos¹

2018

J Surg Anesth

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Objective: Microsurgery has found early application in pediatric population despite the initial concerns on the technically challenging microanastomosis. Complex injuries of lower extremities in children have not received the same attention in the international literature, but some specific accidental foot injuries seem to have a particularly high frequency in that age group. The muscle flaps were initially the choice for the coverage of distal lower limb deficits; however, the donor site morbidity and the bulky appearance attracted attention to more delicate flaps, with the fasciocutaneous anterolateral thigh (ALT) flap becoming a basic reconstructive option. The present study considered all journal abstracts and articles on the use of free flaps in children's extremities in order to evaluate the use of the free ALT flap in pediatric patients. The literature search was performed with "PubMed" and "MEDLINE" databases according to PRISMA guidelines with the systematic review clustering eventually the results of 12 different studies. We investigated the use of 102 free ALT flaps for the reconstruction of traumatic foot defects in children with 95.1% flap survival rate and only 2 complete flap losses noted due to venous thrombosis; 6 flaps went for urgent re-exploration resulting in the unavoidable loss of one flap and the partial necrosis of 3 others. In the vast majority of cases the reconstruction was delayed and the total complication rate was 21.57%. It is reaffirmed that hypertrophic scarring tends to be more common in pediatric patients and split thickness skin graft should be avoided whenever primary closure without extensive tension is possible. More than a quarter (27.27%) of the children necessitated a secondary revision surgery, as the child's growth and the additional fat tissue make secondary debulking procedures really common. Special perioperative care, atraumatic dissection technique, and well established microsurgical experience are absolutely required when performing a free flap reconstruction in children. Nevertheless, the good functional outcome and the high survival rate of our review highlight the reliability of the free ALT flap for traumatic defects in pediatric foot.

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“…[2][3][4] With recent advances in microsurgical and supermicrosurgical techniques, successful pediatric free tissue transfer has been consistently reported for a variety of indications, even in infants and small children. [5][6][7][8][9][10][11][12][13][14][15][16] More recent studies are focusing on evaluating pediatric outcomes, with the goal of optimizing reconstruction and reducing complications. 5,[17][18][19][20] The saying that "children are not small adults" is often used to emphasize the anatomical, physiologic, and pharmacologic features that are distinctive to children.…”

mentioning

confidence: 99%

“…2–4 With recent advances in microsurgical and supermicrosurgical techniques, successful pediatric free tissue transfer has been consistently reported for a variety of indications, even in infants and small children. 5–16 More recent studies are focusing on evaluating pediatric outcomes, with the goal of optimizing reconstruction and reducing complications. 5,17–20…”

mentioning

confidence: 99%

Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer

Mountziaris

Rudolph

Fournier

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Microsurgical free tissue transfer has been successfully implemented for various reconstructive applications in children. The goal of this study was to identify the best available evidence on perioperative management of pediatric patients undergoing free tissue transfer and to use it to develop evidence-based care guidelines. Methods: A systematic review was conducted in the PubMed, Embase, Scopus, and Cochrane Library databases. Because a preliminary search of the pediatric microsurgical literature yielded scant data with a low level of evidence, pediatric anesthesia guidelines for healthy children undergoing major operations were also included. Exclusion criteria included vague descriptions of perioperative care, case reports, and studies of syndromic or chronically ill children. Results: Two hundred four articles were identified, and 53 met inclusion criteria. Management approaches specific to the pediatric population were used to formulate recommendations. High-quality data were found for anesthesia, analgesia, fluid administration/blood transfusion, and anticoagulation (Level I Evidence). Lower quality evidence was identified for patient temperature (Level III Evidence) and vasodilator use (Level IV Evidence). Key recommendations include administering sevoflurane for general anesthesia, implementing a multimodal analgesia strategy, limiting preoperative fasting, restricting blood transfusions until hemoglobin level is less than 7 g/dl unless the patient is symptomatic, and reserving chemical venous thromboembolism prophylaxis for high-risk patients. Conclusions: Pediatric-specific guidelines are important, as they acknowledge physiologic differences in children, which may be overlooked when extrapolating from adult studies. These evidence-based recommendations are a key first step toward standardization of perioperative care of pediatric patients undergoing plastic surgical procedures, including free tissue transfer, to improve outcomes and minimize complications.

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Use of Innovative Technologies in Pediatric Lower Extremity Reconstruction

Cited by 5 publications

References 10 publications

Management of Large Pediatric Wound Defects Using a Continuous External Tissue Expander

Management of Large Pediatric Wound Defects Using a Continuous External Tissue Expander

The Free Anterolateral Thigh (ALT) Flap for Microsurgical Reconstruction of Traumatic Defects in Pediatric Foot

Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer

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