The evolution of pediatric soft-tissue free flap reconstruction of the lower extremity after oncologic resection: A 30 year experience Journal Article
| Authors: | Cohen, Z.; Plotsker, E.; Graziano, F.; Cordeiro, P.; Disa, J.; Mehrara, B.; Fabbri, N.; Azoury, S. C.; Shahzad, F. |
| Article Title: | The evolution of pediatric soft-tissue free flap reconstruction of the lower extremity after oncologic resection: A 30 year experience |
| Abstract: | Introduction: Limb salvage has become the standard of care for lower extremity tumors because of improvements in adjuvant treatments and reconstructive techniques. While there is literature assessing pediatric lower extremity free flap reconstruction in the setting of trauma, there is a paucity of literature that analyzes oncologic free flap reconstruction in this patient population. We report our long-term experience and evolution of care for lower extremity oncologic free flap reconstruction in pediatric patients. Methods: This is a retrospective case series of all patients ≤18 years of age who underwent oncologic soft-tissue microvascular reconstruction of the lower extremity, from 1992 to 2021. Data were collected for patient demographics, oncologic treatment, operative details, and post-operative outcomes. Functional outcomes were assessed by weight bearing status, ambulation, and participation in activities-of-daily-living (ADLs), and musculoskeletal tumor society (MSTS) scores. Results: Over the 30-year study period, inclusion criteria were met by 19 patients (11 males, 8 females) with a mean age of 13.8 years and a mean follow-up of 5.3 years. At last follow-up, 13 patients (68.5%) were alive. The most common pathology was osteogenic sarcoma (13 patients, 68.5%). Sites of reconstruction were the hip (n = 1), thigh (n = 5), knee (n = 4), leg (n = 7), and the foot (n = 2). The most commonly used flaps were latissimus dorsi (n = 8), gracilis (n = 4), and anterolateral thigh ± vastus (n = 4). Postoperative complications occurred in nine patients (43%). Overall flap success rate was 95%. At latest follow-up, ambulation without assistive device was obtained in 11 patients (58%), full weight bearing was achieved by 13 patients (68.5%), and ADLs could be performed independently by 13 patients (68.5%). Mean MSTS score was 23.1/30. Conclusion: Microvascular reconstruction for oncological lower extremity defects in the pediatric population has high limb salvage rates and good functional outcomes. © 2023 Wiley Periodicals LLC. |
| Keywords: | osteosarcoma; adolescent; adult; child; clinical article; preschool child; cancer surgery; limb salvage; surgical technique; young adult; outcome assessment; follow up; retrospective study; cancer therapy; ewing sarcoma; postoperative complication; soft tissue; daily life activity; spindle cell sarcoma; free tissue graft; microvasculature; desmoid tumor; case study; demographics; mobilization; reconstructive surgery; latissimus dorsi muscle; ameloblastoma; human; male; female; article; lower limb; pediatric patient; albendazole; full weight bearing |
| Journal Title: | Microsurgery |
| Volume: | 44 |
| Issue: | 1 |
| ISSN: | 0738-1085 |
| Publisher: | Wiley Liss |
| Date Published: | 2024-01-01 |
| Start Page: | e31130 |
| Language: | English |
| DOI: | 10.1002/micr.31130 |
| PUBMED: | 37877296 |
| PROVIDER: | scopus |
| PMCID: | PMC11296888 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Farooq Shahzad -- Source: Scopus |
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