Preexpanded Perforator Flaps of the Dorsolateral Trunk in Pediatric Patients

Abstract

Contractures and broad scars of the axilla, anterior chest wall, and neck have detrimental effects on functional, physical, and psychological development of children. Perforator flaps have already been shown to be reliable options for the reconstruction of contractures, but there have been no reports demonstrating the value of preexpanded perforator flaps of the dorsolateral trunk region in the treatment of extensive contractures and scars of pediatric patients. The purpose of this study was to demonstrate these techniques by a case series formed of pediatric patients with broad scars and contractures of the anterior chest wall, axilla, neck, and breasts. Seven pediatric patients (mean age, 11.6 years) who were treated by preexpanded perforator flaps are presented. By this means, clinical experience regarding the intercostal artery perforator, thoracodorsal artery perforator, circumflex scapular artery perforator, and lumbar artery perforator flaps was shared. Flaps as large as 21 × 11 cm could be successfully transferred in pediatric patients. Broad scar tissues were resurfaced with broad flaps carrying similar characteristics with the uninjured anterior chest wall and neck skin in six of the authors' patients. In one patient with partial necrosis, a full-thickness skin graft was used for the residual defect. The mean duration of postoperative (after flap transfer) follow-up was 17.2 months. The preexpanded thoracodorsal artery perforator, intercostal artery perforator, and circumflex scapular artery perforator flaps are useful and effective reconstructive options for the treatment of scars and contractures of the anterior chest wall, axilla, neck, and breast in pediatric patients. : Therapeutic, IV.