Perioperative Characteristics of Adolescent Patients Undergoing Free Tissue Transfer in the Reconstruction of Craniomaxillofacial Defects

Introduction: Free tissue transfer is often utilized in head and neck reconstruction for a variety of pathologic and traumatic defects.¹ Within the field of oral and maxillofacial surgery, the use of this technique in pediatric populations has not been widely discussed in the literature but has been used with some success.² Therefore, we conducted a retrospective review of patients who underwent free flap reconstruction with the goals of characterizing the perioperative period and assessing this treatment modality in an adolescent population.

Methods: We conducted a single institution retrospective chart review of patients ages 10-18 who underwent free flap reconstruction between July 2007 and June 2015. Both benign and malignant diagnoses reconstructed with free tissue transfer were considered for inclusion. Standard descriptive statistical methods were used to analyze demographic, procedural, and surgical/donor site data and complications.

Results: A total of nine patients diagnosed with benign and malignant conditions were reviewed. The average length of stay was 7.44±2.96 days. In those patients available for follow up at 6 months (n=8), seven flaps (87.5%) remained without major complication. One patient (12.5%) had a major complication that resulted in partial loss of flap tissue. The most common follow up issues were minor and included donor site complications (n=5, 62.5%), wound complications (n=3, 37.5%), and infection (n=2, 25%). Several patients (n=5, 62.5%) also had cosmetic concerns, such as hypertrophic or hyperpigmented scars, lip incompetence, or flap bulk. One patient developed heterotopic ossification of the flap pedicle.

Conclusions: Reconstruction of large facial defects with free tissue transfer is a successful method in the pediatric population. Although there were some minor complications, patients in general tolerated the procedure well in the perioperative period. Additional studies and larger, standardized chart reviews and cohort studies are required to better characterize perioperative considerations and to associate them with long term outcomes.

References:

1. Markiewicz MR, Bell RB, Bui TG, Dierks EJ, Ruiz R, Gelesko S, et al. Survival of microvascular free flaps in mandibular reconstruction: A systematic review and meta-analysis. Microsurgery. 2015 Oct;35(7):576-87.

2. Guo L, Ferraro NF, Padwa BL, Kaban LB, Upton J. Vascularized fibular graft for pediatric mandibular reconstruction. Plast Reconstr Surg. 2008 Jun;121(6):2095-105.