Systematic Review of Free Tissue Transfer Used in Pediatric Lower Extremity Injuries

Mehul Thakkar, MBBS; Bartlomiej Bednarz, MBBS, MA(Cantab)


ePlasty. 2021;21:e2 

In This Article


In total, 240 studies were retrieved from the search using the aforementioned key words. Thirty-nine titles were selected and after reviewing the abstracts, 10 articles fit the inclusion and exclusion criteria. Data extracted from the 10 relevant studies included number of patients, number of free flaps, age (mean/range), total complete flap failure rate, flap types, location of trauma, time period of data collection, country of institution where the study took place, and type of study. Levels of evidence were assigned to each study according to the Oxford levels of evidence 2.[3] Results are shown in Table 1, Table 2 and Table 3.

Among the 10 studies included in the study, there were a total of 220 free flaps used to reconstruct traumatic lower-limb defects. The age range was between 2 and 17 years. The total complete flap failure rate was 4.5% (10/220). The anterolateral thigh (ALT) perforator flap was the commonest flap used (n = 59), and the latissimus dorsi (LD) flap was the commonest muscle flap used (n = 51). Sixty-five percent of flaps were fasciocutaneous/perforator, while muscle flaps accounted for 33% of flaps. The commonest area of reconstruction was the foot and ankle region, accounting for 72% (116) of defects (N = 161), as location of defect could not be extracted from 3 studies.