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Forecasting The Flap: Predictors For Pediatric Lower Extremity Trauma Reconstruction
Kasra N. Fallah, BSA, Brady J. Anderson, BS, Jessica F. Rose, DO, Grigorios A. Lamaris, MD PhD, Phuong D. Nguyen, MD, Matthew R. Greives, MD.
University of Texas Health Sciences Center at Houston, Houston, TX, USA.

PURPOSE: Post-traumatic reconstruction of the lower extremity has continued to be challenging, even with abundant advances in the surgical field. Due to the larger volume of cases in adults compared to children, the majority of the medical literature has focused on adult lower extremity reconstruction. However, the procedures performed in adults are not always translatable to the growing pediatric population. There are specific concerns regarding the technical difficulty of pediatric free flaps due to the lack of tissue availability, tendency of vessel vasospasm, and small vessel size. This study describes the risk factors associated with the need for free flap reconstruction in the pediatric population following lower extremity trauma.
METHODS: An IRB-approved retrospective chart analysis over a 5-year period (January 1, 2012 to December 31, 2017) was performed analyzing all pediatric patients (<18 years old) diagnosed with one or more lower extremity wounds at the Memorial Hermann Trauma Institute. Age, sex, median income, race, mechanism of injury, trauma type, trauma team activation, and injury severity score were reviewed. Statistical analysis consisted of univariate and multivariate regression models to compare the free flap and no free flap cohorts.
RESULTS: One thousand eight hundred twenty-one patients were identified who fit our search criteria. Out of these patients, free flap reconstruction was observed in forty-one (2.25%) cases, local flap reconstruction was observed in sixty-five (3.57%) cases, and skin graft reconstruction was observed in nineteen (1.04%) cases. Increased age (OR 1.134; p=0.002), all-terrain vehicle accidents (OR 6.698; p<0.001), and trauma team activation (OR 2.443; p=0.034) were associated with the need for free flap reconstruction following lower extremity trauma in the pediatric population.
CONCLUSION: Pediatric free flaps are only used in a small percentage of traumatic lower extremity cases. However, our study demonstrates higher rates in older patients, all-terrain vehicle accidents, and with trauma team activation. This information can be implemented to help develop an early risk calculator that defines the need for complex lower extremity reconstruction in the pediatric population. Further analyses should include surgical-specific variables in addition to diagnosis, procedure, outcome, complication, and comorbidity data.


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