Microvascular reconstruction for tumors of the head and neck in the pediatric population

Abstract

Introduction: Microsurgical tissue transfer in the pediatric population is challenging for several reasons– small vessel diameter, flap size, difficulties with postoperative flap monitoring, and difficulty in anticipating tissue growth and remodeling. In addition, head-and-neck reconstruction is uniquely difficult due to the functional deficits after ablative surgery. We present our series of microvascular reconstruction for tumors of the head and neck in the pediatric population. Materials and Methods: Retrospective review of microvascular reconstruction performed in our institution for benign and malignant tumors of the head and neck for patients aged <10 years of age between 2004 and 2016. Demographic and treatment details were analyzed, and descriptive statistics were performed. Results: The flaps used for reconstruction were anterolateral thigh flap (n = 5), fibula free flap (n = 4), scapular free flap (n = 2), radial forearm free flap (n = 1), and sixth rib with serratus anterior and latissimus dorsi (growth center transfer) (n = 1). Rapid prototyping models and inverse planning were used for bony reconstruction in seven cases. The flap success rate was 100%. The average operating time was 130 min. There were no major intraoperative or postoperative complications. Conclusion: Microvascular reconstruction for head-and-neck tumors in the pediatric age group is safe and is associated with good functional and esthetic outcomes. The anterolateral thigh flap and the fibula flap are the flaps of choice in a majority of cases. Preoperative planning, especially in complex bony reconstruction, is important to maximize outcomes and minimize the operative time. Multidisciplinary care is essential to ensure rapid rehabilitation in the postoperative period.