Dados do Trabalho

Título

ORTHOPLASTIC RECONSTRUCTION IN CHILDREN: ARE THE RISK FACTORS SIMILAR TO THOSE OBSERVED IN ADULTS?

Introdução e Objetivo

Free flaps in the pediatric population are less commonly indicated, because the reconstructive ladder is followed from least complex and sometimes less morbid surgeries to most complex with free flaps for limb reconstruction.
Risk-factors for free flaps complication in adults are extensively discussed in literature, however there is little discussion among children. We assume that children’s risk factors are the same as in adults after literature review. The objective of this study is to describe indications and outcomes (including risk-factors) of free flaps for limb reconstruction in children, as the first indication of treatment in complex injuries.

Material e Método

Patients undergoing microsurgical free flaps in an Orthopedic Hospital were consecutively included in this cross-sectional study, from 2014 to 2020. Data regarding personal medical history, intraoperative microsurgical procedure and laboratory tests were collected. Patients under 18 years of age were included. Complications and free flap outcomes were observed during follow-up.

Resultados

This study included 23 free flaps in 23 patients with orthoplastic reconstruction. The free flap was performed as reconstructive elevator concept. The most common indications were skin or bone defects caused by trauma (9), tumor (6) and congenital pseudarthrosis of the tibia (4). The most indicated flap was vascularized fibular flap in 10 patients, followed by anterolateral thigh flap in 5 patients. Complications were observed in 5 patients. 93% of patients with inferior limb reconstruction walked at final evaluation. Among risk factors studied, when only the superficial venous system was used had a higher incidence of complications (p=0,03).

Discussão

As free flap in children is an uncommon surgery, conclusions among risk-factors for complications are not reliable, even for systematic reviews, as complications are variable among papers, however, when we observe the risk-factors described in literature, such as timing of free flap in trauma, size mismatch and arterial injury, we observed that they are also common risk factors described in surgeries performed in adults

Conclusão

Free flaps in children are safe and indications are restricted to precise indications to provide alternatives to amputations and improve patient’s function. We observed an increase in the incidence of complications when only superficial veins were used for free flap outflow in children