Free flaps to replace extensive and deep limb defects in children

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Abstract

BACKGROUND: Extensive and deep limb defects remain a difficult problem of reconstructive surgery in children. Free microsurgical flaps are used to resolve this problem. Free flaps can be complex in composition and include muscles and bone parts, which allow replacing large and multicomponent limb defects. The technique is used in patients with posttraumatic deformities, burns, acquired limb deformities, and congenital deformities of the extremities.

AIM: To retrospectively analyze free flaps in children for the replacement of limb defects.

MATERIALS AND METHODS: This single-center retrospective study analyzed 120 cases of microsurgical autotransplantation of free flaps to replace defects of the upper and lower extremities in children. The patients were children aged 1–17 years who had injuries and burns, acquired limb deformities, and congenital limb deformities.

RESULTS: The average age of the patients was 9.5 years, and 72% of the patients were boys. Moreover, 95% of the children had posttraumatic deformities, burns, and acquired pathologies. Free latissimus dorsi flaps were used in 70% of the patients. The recipient area was the upper limb in 53% of the cases. The survival rate of free flaps was 96%. The general surgical complications were inflammation, pneumothorax, deformities, and specific vascular thrombosis.

CONCLUSIONS: Replacement of extensive limb defects with free flaps remains a practical method in children.

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About the authors

Denis Y. Grankin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: grankin.md@gmail.com
ORCID iD: 0000-0001-8948-9225

MD, Research Associate

Russian Federation, Saint Petersburg

Sergey I. Golyana

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: ser.golyana@yandex.ru
ORCID iD: 0000-0003-1319-8979
SPIN-code: 8360-8078

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Natalia V. Avdeychik

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: natali_avdeichik@mail.ru
ORCID iD: 0000-0001-7837-4676
SPIN-code: 6059-4464
Scopus Author ID: 57193273547

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Andrey V. Safonov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: safo125@gmail.com
ORCID iD: 0000-0003-1923-7289

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Tatyana I. Tikhonenko

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: Tikhonenko_turner@mail.ru
ORCID iD: 0000-0002-5379-6028

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Natalia S. Galkina

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: galkinadoc@gmail.com
ORCID iD: 0000-0001-9201-7827

MD, orthopedic surgeon

Russian Federation, Saint Petersburg

Ekaterina A. Zakharyan

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: zax-2008@mail.ru
ORCID iD: 0000-0001-6544-1657
SPIN-code: 4851-9908
Scopus Author ID: 57193258044
ResearcherId: T-3072-2018

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Konstantin A. Afonichev

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: afonichev@list.ru
ORCID iD: 0000-0002-6460-2567
SPIN-code: 5965-6506

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Anastasia I. Arakelian

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: a_bryanskaya@mail.ru
ORCID iD: 0000-0002-3998-4954
SPIN-code: 9224-5488

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
Action
1. JATS XML
2. Figure. Reconstruction of the palmar surface of the hand and forearm: a, gross cicatricial deformity of the palmar surface of the hand and forearm; b, a defect of the palmar surface of the hand and forearm after excision of scar tissue; c, defect in the palmar surface of the hand and forearm replaced by a periscapular flap; d, result 2 years after surgical treatment

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