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Othman et al. Plast Aesthet Res 2022;9:21 Plastic and
DOI: 10.20517/2347-9264.2022.03
Aesthetic Research

Original Article Open Access

Free tissue transfer for lower extremity trauma in the
pediatric patient

Sammy Othman, Denis Knobel

Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health, New York, NY 11021, USA.
Correspondence to: Dr. Sammy Othman, Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell
Health, 600 Northern Blvd, Great Neck, New York, NY 11021, USA. E-mail: Sothman@northwell.edu; sothman13@gmail.com

How to cite this article: Othman S, Knobel D. Free tissue transfer for lower extremity trauma in the pediatric patient. Plast
Aesthet Res 2022;9:21. https://dx.doi.org/10.20517/2347-9264.2022.03

Received: 13 Jan 2022 First Decision: 24 Jan 2022 Revised: 26 Jan 2021 Accepted: 11 Feb 2022 Published:18 Mar 2022

Academic Editor: Matthew L Iorio Copy Editor: Jia-Xin Zhang Production Editor: Jia-Xin Zhang

Abstract
Aim: The utilization of free-tissue transfer secondary to traumatic lower extremity defects in the pediatric
population is scarcely described. Factors include microsurgeon inexperience, inadequate center resources, and fear
of historically described poor surgical outcomes. The aim of this study is to investigate more recent articles
describing free-flap microsurgical reconstruction for these defects.

Methods: A systematic review of the literature was conducted through the online databases PubMed, Embase, and
Web of Science, examining for articles with at least 20 subjects utilizing free-tissue transfer for soft-tissue defects
of the pediatric (aged 18 and younger) lower extremity following traumatic etiology since 2005. Outcomes
included flap failure, return to the operating room, and functional status, where available.

Results: Seven studies were deemed appropriate for inclusion, with a total of 243 flaps included. Motor vehicle and
motorcycle accidents were greater than 75% of total etiology. Most defects involved the foot or ankle (65.1%). In
total, perforator flaps compromised the majority of flaps (54%), with the most common being the anterolateral
thigh, the scapular/parascapular, and deep inferior epigastric flaps. Less common perforators included the groin
flap, tensor fascia lata, radial forearm, lateral arm, and thoracodorsal perforator flap. Muscle-based flaps were less
common (46%), with the latissimus dorsi and rectus muscle flaps composing the majority. The most commonly
used recipient vessel was the anterior tibialis (49.5%) and posterior tibialis vessels (45.3%). Most studies
performed reconstruction within 7-10 days of presentation. There was a cumulative 6.5% flap failure rate.

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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