Free Perforator Flaps in Children

On the one hand, perforator flaps are said to be tedious to dissect and technically demanding. On the other hand, they can provide ample skin, based on the sturdy and well-known vascular pedicles of their musculocutaneous counterparts, without their bulkiness and donor-site morbidity. In adults, they have already proved their usefulness and reliability in various clinical situations. The authors presented a series of 15 consecutive free perforator flaps performed by the first author in 14 children, aged 6 months through 16 years at operation (mean age: 6 years 7 months).

All children presented with soft-tissue defects of the lower limb necessitating coverage with a skin flap. Especially in children, donor sites are scarce, when looking for long and reliable vascular pedicles of sufficient size to allow for feasible microanastomosis away from the site of injury, together with minimal donor-site morbidity. Flaps that were involved included 4 deep inferior epigastric artery perforator flaps, 5 thoracodorsal artery perforator flaps, and 6 compound (chimera) thoracodorsal artery perforator flaps.

All but one flap were successful. With a follow-up of 1 to 6 years, operative time, outcome, and complications compared favorably to those of perforator flaps in adults, or even to other free flaps in the pediatric population. This indicated that in children also, perforator flaps could be an alternative to the traditional muscle or myocutaneous free flaps for reducing donor-site morbidity in these complex reconstructions.