Microsurgical reconstruction in pediatric patients: a series of 30 patients.

BACKGROUND: Free flap surgery in the pediatric population has gained widespread acceptance regarding its technical utility and reliability. Initial concerns as to the feasibility and reliability of the procedure in children were resolved over time. METHODS: Thirty children (15 boys, 15 girls) were treated in Sisli Etfal Training and Research Hospital, Plastic and Reconstructive Surgery Clinic. Their mean age was 10.8 years. Defects were located on the lower extremity (n=22), head and neck (n=5) and upper extremity (n=3). The etiologies of the defects included vehicle accident, sequelae of burn, traumatic contractures, crush injury, epulis in the maxilla, and gunshot wound. RESULTS: The free flaps performed in our series were latissimus dorsi muscle flap, combined latissimus dorsi and serratus muscle flaps, serratus anterior muscle flap, cross latissimus dorsi muscle flap, scapular osteomyocutaneous flap, parascapular fasciocutaneous flap, fibular osteocutaneous flap, anterolateral thigh flap, medial circumflex femoral artery perforator flap, and crista iliaca osteocutaneous flap. CONCLUSION: The advantages of free flaps in children, which include better adaptation of the flap growth and better learning capacity of the children, provide the surgeon with more satisfactory functional and aesthetic results.

The feasibility of tissue expansion in reconstruction of congenital and aquired deformities of pediatric patients.

Skin expansion is one of the major developments in reconstructive surgery. The use of tissue expansion has been popularized among plastic surgeons and has become the treatment method of choice for many congenital and acquired defects in a wide variety of diseases in adults and then later in children. The authors analyze their clinical experience in the treatment of burn scars and complex defects by tissue expansion in pediatric patients. The study included thirty five expansion procedures performed in 25 patients. Smooth surface expanders with a remote valve were used in the scalp (22), face (2), neck (3), hand (2), thorax (2), breast (1), palate (2), abdomen (1). Self-inflating osmotic tissue expanders were used in four patients, one of them had cleft palate and the other two of them had congenital hand anomalies and the last one had frontal scar and alopecia in the frontal hairline. In 19 out of 25 cases (76%) tissue expansion was achieved without complications. At the same time, in 1 cases minor complications and in 5 cases major complications occurred. The number of expanders per patient was only one in 16 cases. More than one expander was used to remove parts of the same injury in 9 cases. Our study may help to draw attention again on different aspects in tissue expansion and critically focus on each step of the tissue expansion both using self-filling tissue expanders and smooth surface tissue expanders with a remote valve.

Two-suture fish-mouth end-to-side microvascular anastomosis with fibrin glue.

The most decisive step during free tissue transfers and replantation surgery may be respected as microvascular anastomosis. The conventional end-to-side anastomosis technique with simple interrupted sutures is well established and proven to be successful. On the other hand, conventional technique can be time consuming and can cause vascular thrombosis, vessel narrowing, and foreign-body reactions. Search for a more rapid and secure alternative to conventional technique is carried on. In this study, we defined a new technique for end-to-side anastomosis with fish-mouth incisions and application of fibrin glue and compared our results with those we obtained with conventional end-to-side anastomosis. We evaluated end-to-side anastomosis of carotid arteries of a total number of 64 Wistar-Albino rats. In control group (n = 32), conventional anastomoses with 8 to 10 sutures were performed. In experimental group (n = 32), fish-mouth incisions were applied first on the recipient artery, followed by performing anastomosis with only 2 corner sutures and applying commercially available fibrin glue. Time taken to perform the anastomosis was significantly shorter with the experimental group (P = 0.001), whereas early and late patency and aneurysm rates were comparable to those achieved with control group. Histological evaluation did not point out any significant differences between the groups. We have defined a rapid and safe alternative technique of end-to-side anastomosis with the use of fibrin glue. This method may be an alternative especially where multiple anastomoses are required or where it is difficult to approach anastomotic line, as it is easily performed, rapid, safe, and not involving any complex equipments.

Clinical outcomes of myelomeningocele defect closure over 10 years.

We report our surgical procedures for the closure of myelomeningocele defects. A retrospective analysis of 162 patients (74 male [45.7%], 88 female [54.3%]) with myelomeningocele was performed and the relationship between hydrocephalus, neurological status and the level and size of the myelomeningocele was described according to type of defect closure. Patients were divided into four groups according to the size of the defect, which was classified into ranges of 0-24 cm(2), 25-39 cm(2), 40-60 cm(2) and >60 cm(2). Myelomeningocele occurred in the lumbar region in 114 patients (70%). The minimum defect size was 3×2 cm, and the maximum defect size was 15×15 cm (mean defect size=34.64 cm(2)). We found that primary closure can be performed on clean, small defects with an intact sac that contains cerebrospinal fluid and the neural placode. For defects larger than 25 cm(2) that contained perforated sacculas, more soft tissue for well-vascularized coverage was required. Bilateral V-Y fasciocutaneous flaps are a good choice for immediate coverage of myelomeningocele defects.