Purpose: A critical evaluation of the indications, success, complications and long term outcomes of tissue transfers in children is needed.
Methods: A review of 433 free transfers in 296 children performed by the author in a large Children's Hospitalhas been completed. These free flaps were performed in all parts of the body: extremities (30% upper, 25% lower, H&N 38%, others 7%) between 1977 and 2005. Mean follow-up was 9 years.
Results: Two of the 433 flaps failed completely. All of 10 patients returned to the OR for early problems had successful salvage of their transfers. Complications were significantly less than those in the adult age group. Favorable outcomes were acieved in all but 12 of these youngsters.
Conclusions: Children are not small adults. The indications for these microsurgical procedures are different. Technical challanges in thesee small patients are greatly enhanced and careful coordination with the ICU is mandatory post operatively. Superior sensory return, the paucity of associated diseases, unscarred anatomy, and the opportunity to follow these patients through childhood, adolescence into adulthood and the unusual and unique problems seen in children make this a fascinating group of patients. The unexpected result may often occur. Continued follow-up and careful documentation of these children during growth periods is mandatory. New, innovative techniques are easily utilized in these patients.