Donor site morbidity after free flap procedure in children and adolescents: a retrospective analysis
Bibliographic record
Abstract
Background: Microsurgery using free flaps is a crucial component of reconstructive surgery, utilized to repair and reconstruct tissue defects resulting from trauma, congenital anomalies, infections, or oncologic resections. In pediatric and adolescent patients, the application of flap surgery poses unique challenges and requires specialized approaches due to differences in anatomy, growth potential, and psychological considerations. The aim of this investigation was to analyze specific flap characteristics and each donor site morbidity following free flap procedures in this challenging patient population. \nMethods: This retrospectively conducted investigation analyzed general outcomes and specific donor site characteristics following free flap surgery in pediatric patients. The study included 19 patients and 24 free flaps. Postoperative Follow-up ranged from eight to 100 months. Data, including patient demographics, perioperative data and complications, were analyzed and compared. In addition, we performed a long-term evaluation of the donor site and flap characteristics in ten patients (13 flaps). We used standardized tests to assess the donor site: The International Scar Classification (2019), the Vancouver Scar Scale (1990) (1) and the Patient Observer Scale Assessment Scale (POSAS). Appropriate statistical analysis was performed. \nResults: The incidence of major complications was 8.33%. One SCIP flap was lost due to arterial and venous thrombosis, which resulted in a flap survival rate of 96%. The incidence of minor complications was 8.33%, including cases of seroma and hematoma. Long-term assessments revealed that most flaps exhibited minor scarring according to the VSS, with the exception of one MPAP flap, which demonstrated moderate scarring. The International Scar Classification indicated that all scars were mature and flat, except for one hypertrophic, wide MPAP scar. The POSAS overall opinion from patients ran \nDiscussion: This study has shown that there are relevant differences between donor sites that should be considered when determining the indication for free flap procedures in children. Careful preoperative planning, surgery, and special patience are necessary to achieve successful flap surgery in children and adolescents. Continuous and long-term follow-up is equally important, particularly to monitor donor site characteristics during growth. Long-term evaluations demonstrated a favorable scar appearance with a minimal impact on quality of life, thereby substantiating the efficacy of these procedures in the pediatric population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".