Microvascular Soft Tissue Reconstruction Outcomes and Risk Factors in Pediatric Patients Undergoing Head and Neck Reconstruction

Despite improvements in microsurgical techniques and broad application of free tissue transfer for reconstruction in the adult population, there is currently a paucity of literature regarding microsurgical reconstruction in the pediatric population, notably a limited number of case series evaluating outcomes following head and neck reconstruction. A retrospective analysis of National Surgical Quality Improvement Program Pediatric (NSQIP-P) database from 2015 to 2020 was performed. Pediatric patients undergoing head and neck reconstruction with microvascular muscle and fasciocutaneous flaps were identified using Current Procedural terminology codes (CPT). Multivariate logistic regressions were conducted to assess postoperative outcomes of interest. A total of 120 head and neck free flap reconstructions were performed in the pediatric population. Most free flaps were microvascular muscle (n = 82, 68%) followed by fasciocutaneous (n = 38, 32%) flaps. The surgical complication rate was 8% (n = 9) and was primarily due to wound infection 6% (n = 7), whereas medical related complication rate was 14% (n = 17) with majority of patients requiring blood transfusion 12% (n = 14). The median length of stay was 4 days, and ventilator dependence was found to be significantly different among microvascular free flap types. Patients with underweight BMI and ASA Class >2 had higher odds (OR 59.7 and 17.0, P < .05 respectively) of developing any complication for microvascular muscle flaps. Analysis of a national cohort of pediatric patients revealed a low flap-related complication rate. Although free flap reconstruction in the pediatric population is technically demanding, microsurgical free tissue transfer in this population is safe and should be considered if indicated.