Challenges in Microsurgical Free Tissue Transfer for a 1-Year-Old Child

Abstract

Challenges faced during complex reconstructions in the pediatric age group are rarely discussed in literature. This study is to share our experience in a 1-year-old patient. The patient had an exposed knee joint following trivial trauma, which was resurfaced with a free latissimus dorsi flap. On the patient’s 5th day in the ward, the flap was discolored and inadequate perfusion was noted. The patient also had loose stools overnight. Before she was re-examined, the dressings were loosened and the patient was kept warm and was started on intravenous fluids. When examined in the operating room, the vascularity of the flap had improved without any intervention. The monitoring skin paddle necrosed while the muscle survived. The patient then underwent skin grafting and had uneventful recovery. The postoperative monitoring in children is critical as they have poor reserves and are prone to complications. We believe pediatric microsurgery should be done in specialized microsurgical centers that also have good intensive care units.