Outcome and utility of scoring systems in the management of the mangled extremity.

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Abstract

[Indexed for MEDLINE] 17. J Plast Reconstr Aesthet Surg. 2022 Nov;75(11):3970-3978. doi: 10.1016/j.bjps.2022.06.090. Epub 2022 Jun 28. Thin and superthin free flaps: An innovative approach to pediatric extremity reconstruction. Glass GE(1), Staruch RM(2), Sivakumar B(3), Stotland MA(4). Author information: (1)Attending Plastic & Craniofacial Surgeon, Department of Surgery, Sidra Medicine, Doha, Qatar; Associate Professor of Clinical Surgery, Weill Cornell Medical College, New York, Qatar. Electronic address: gglass@sidra.org. (2)Trainee in Burns, Plastic & Reconstructive Surgery & DPhil Student, University of Oxford, Oxford, United Kingdom. (3)Attending Plastic, Reconstructive and Hand Surgeon, Department of Surgery, Sidra Medicine; Consultant Plastic Surgeon, Great Ormond Street Hospital for Children, London, UK. (4)Associate Professor of Clinical Surgery, Weill Cornell Medical College, New York, Qatar; Division chief, Plastic, Craniofacial and Hand surgery, Department of Surgery, Sidra Medicine. Comment in J Plast Reconstr Aesthet Surg. 2023 Mar;78:73-74. doi: 10.1016/j.bjps.2023.01.037. INTRODUCTION: Published standards for the management of open extremity fractures have improved limb salvage, fracture union, and deep infection rates, but the aesthetic and functional importance of our flap choices has been overlooked. Thin and superthin free flaps exhibit advantages over traditional free flaps in some situations but have seldom been reported in children. The aim of this paper is to present our experience of thin and superthin free flaps in pediatric extremity reconstruction. METHODS: Children (≤13 years) who underwent soft tissue reconstruction using a thin and superthin free flap following major extremity trauma are presented. RESULTS: Five patients (5 flaps) met the inclusion criteria. The median age was 9 (range 6-13). There were 3 Gustilo IIIB open fractures and 2 multiplanar degloving injuries. The median mangled extremity severity score (MESS) was 4 (range 2-6). The median time from injury to definitive soft tissue closure was 72 h (range 28-120 h). Four anterolateral thigh (ALT) flaps were raised as thin flaps, and 1 superficial circumflex iliac artery perforator (SCIP) was raised as a superthin flap. There was one re-exploration owing to venous congestion, and a second venous anastomosis was performed to enhance flap drainage. The same ALT flap exhibited necrosis at one margin, which was debrided and grafted before discharge. There were no other flap complications. No flap-related secondary surgeries were required. CONCLUSION: Thin and superthin free flaps are viable options in pediatric extremity reconstruction. They exhibit excellent aesthetic and functional contouring when a slender fasciocutaneous flap is needed, especially when body habitus renders traditional options unfavorable. Copyright © 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. DOI: 10.1016/j.bjps.2022.06.090